Structural and functional cardiac remodeling in patients with arterial hypertension and progression of atrial fibrillation

Aim: To evaluate cardiac remodeling based on echocardiographic parameters over time in patients with arterial hypertension (AH), with and without progression of atrial fibrillation (AF).

Materials and methods: The study includes 59 patients with AH and paroxysmal AF. The observation period was 20 [19.0; 25.0] months. The criteria for AF progression were considered to be the transition from paroxysmal to persistent or permanent forms, or an increase in the frequency and/or duration of arrhythmia episodes. All patients underwent transthoracic echocardiography.

Results: In patients with AF progression a deterioration in parameters reflecting left ventricular (LV) diastolic function was observed: an increased ratio of the transmitral peak velocity of early filling (peak E) relative to early diastolic septal mitral annular velocity (E/e’_sept) (p = 0.01), the ratio of peak E to the average early diastolic mitral annular velocity (E/e’_avg) (p = 0.02), and the peak tricuspid regurgitation velocity (p = 0.03). In the group without AF progression, there was a decreased prevalence of left atrial (LA) dilatation by the LA volume index LV mass/height² (93.2% vs. 75.0%, p = 0.03). This group also showed a significant reduction in LV myocardial mass (LVMM) (p = 0.0005), LVMM/height2,7 (p = 0.0008), accompanied by a decreased prevalence of left ventricular hypertrophy (LVH) (65.9% vs. 47.7%, p = 0.04). Echocardiographic parameters of LVH correlate with dynamics in both systolic and diastolic blood pressure.

Conclusion: Structural and functional cardiac remodeling is associated with AF progression, while reverse remodeling is associated with a favorable course of arrhythmia.

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