Features of intracardiac hemodynamics according to echocardiography in patients with arterial hypertension and frequent recurrences of atrial fibrillation

Abstract

Aim - to determine the features of intracardiac hemodynamics according to echocardiography in patients with arterial hypertension (AH) and frequent recurrences of atrial fibrillation (AF). Materials and Methods. There were examined 146 patients aged from 37 to 86 years with AH stage II complicated by frequent recurrences of AF. As a comparison group, there were examined 26 patients aged 39 to 74 years with AH II stage without AF. The duration of the arrhythmic anamnesis ranged from 1 to 30 years and averaged 5.7±0.5 years. Paroxysmal form of AF was observed in 56 (38.4%) patients and persistent form of AF observed in 90 (61,6%) patients. The anamnesis of AH ranged from 1 to 40 and averaged 11.6 ± 0.6 years. The vagal variant of AF was determined in 31 (21.2%) patients, the adrenal variant of AF in 70 (47.9%), and mixed variant of AF in 45 (30.9%) patients. All patients underwent echocardiography according to the standard protocol. Results and Discussion. In the groups of AF (paroxysmal and persistent), compared to group with AH, absolute and relative sizes and volume of left atrium were higher (p<0.0001); IVRT was decreased (p<0.05); the ratio E/A was decreased (p<0.03); and the prevalence of mitral (p<0.03) and tricuspid (p=0.02) valve regurgitation was found. In the group of AH and persistent AF, compared to group with AH, the average ratio E/e' was statistically higher (p=0.03), and the 1 degree of mitral regurgitation prevailed (p=0.02). The group of AH and paroxysmal AF was characterized by higher incidence of 2 degree of tricuspid valve regurgitation (p=0.05) and lower maximum transaortic speed compared to group with AH (p=0.04). In the group of AH and mixed variant of AF, compared to group with AH and vagal variant of AF the 2nd degree of mitral regurgitation prevailed (p=0.05). In the group of AH and adrenal variant of AF the tricuspid valve regurgitation and 1 degree of tricuspid valve regurgitation were prevalent compared compared to group with AH and vagal variant of AF (p=0.02). In the group with AH and vagal variant of AF aortic valve regurgitation (p=0.05) and 1 degree of aortic valve regurgitation (p=0.02) were prevalent compared to group with AH and adrenal variant of AF. Conclusion. In the groups of AH and AF (paroxysmal and persistent) in contrast to group with AH absolute and relative sizes and volume of left atrium were higer, IVRT was decreased, the ratio E/A was decreased, the prevalence of mitral and tricuspid valve regurgitation. In the group of AH and persistent AF in contrast to group with AH were higher ratio E/e 'average and the prevalence of 1 degree of mitral regurgitation. The group of AH and paroxysmal AF was characterized by higher incidence of 2 degree of tricuspid valve regurgitation and lower maximum transaortic speed in contrast to group with AH. In the group of AH and mixed variant of AF in contrast to group with AH and vagal variant of AF the 2nd degree of mitral regurgitation was prevailed. In the group of AH and adrenal variant of AF the tricuspid valve regurgitation and 1 degree of tricuspid valve regurgitation were prevalent in contrast to group with AH and vagal variant of AF. In the group with AH and vagal variant of AF, aortic valve regurgitation and 1 degree of aortic valve regurgitation were prevalent in contrast to group with AH and adrenal variant of AF.

Keywords

• arterial hypertension, atrial fibrillation, echocardiography