Abstract

Possible risk factors contributing to atrial fibrillation occurrence in heart failure mildly reduced ejection fraction

Author(s): Lusine Hazarapetyan, Parounak Zelveian, Svetlana Grigoryan

Background: Heart Failure (HF) is often accompanied by Atrial Fibrillation (AF), which significantly worsens the outcome of both diseases. The purpose of study is to examine possible risk factors for the development of paroxysmal/persistent AF in patients with Heart Failure with moderately reduced Ejection Fraction (HFmrEF).

Methods: The study included 193 patients with HFpEF and non-valvular paroxysmal/ persistent AF after successful cardioversion. As a control group the similar 76 patients without AF were examined. All patients underwent an examination, including electrocardiography, echocardiography, ambulatory blood pressure monitoring and Holter ECG monitoring. Levels of inflammatory markers, such as High-sensitivity C-Reactive Protein (Hs-CRP), Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α) and the fibrotic marker Transforming Growth Factor-β1 (TGF-β1) measured using the Enzyme-Linked Immunosorbent Assay (ELISA) method. The results obtained were analyzed using Odds Ratios (OR).

Results: Frequent episodes of Hypertensive crisis (Hcr) and increased Body Mass Index (BMI) are possible risk factors for paroxysmal/persistent AF. An increase OR of diastolic and systolic parameters of the left ventricle was associated with significant atrial and ventricular remodeling. Higher levels of inflammatory markers OR are associated with an increased risk of AF in HFmrEF patients compared to some patients without AF. An increase in the OR of the fibrosis marker TGF-β1 was statistically significant in patients with persistent AF.

Conclusion: It could be considered that frequency Hcr, BMI, remodeling of the left atrium and ventricles and an increase of inflammation and fibrosis markers are possible risk factors for the occurrence of AF in HFmrEF patients.