Ventricular–arterial coupling indices reflect early stage of left ventricular remodelling in atrial fibrillation

Background: Atrial fibrillation (AF) associated with adverse atrial and ventricular remodelling and with extracellular matrix dysfunction initiating myocardial fibrosis. Ventricular–arterial coupling (VAC) plays a pivotal role in cardiac and aortic adaptation to pathological conditions. The purpose of this study was to examine the effect of paroxysmal AF on fibrotic remodelling reflected in structural and functional changes in left ventricle and large arteries and their coupling. Materials and methods: We carefully selected women and men aged from 40 to 75 years, with paroxysmal AF and sinus rhythm on admission to the hospital, with preserved left ventricle (LV) systolic function, and the carotid-femoral pulse wave velocity (PWV) within normal range. In transthoracic echocardiography LV systolic and diastolic function, stroke volume (SV), and global longitudinal strain (GLS) were assessed. The brachial blood pressure was simultaneously recorded during echocardiographic recording of blood flow velocity in LV outflow track. Following VAC parameters were analysed: arterial elastance (Ea) and LV elastance (Ees). Two-dimensional speckle tracking was used to derive novel VAC parameter PWV to LV GLS ratio. Results: In univariable regression model the Ees increased significantly with AF history duration (p = 0.001), moreover Ees was higher in women than in men (p = 0.002). Ea/Ees ratio decreased significantly with AF history duration (p = 0.005). In multivariable regression models, AF duration was also negatively associated with Ea/Ees ratio, and positively related to Ees. Conclusion: The relationship between AF and LV function is complex and potentially bi-directional. Despite normal LV function, paroxysmal AF can contribute to abnormal heart-vessel coupling, indicating early ventricular remodelling due to arrhythmia, this observation seems to be more pronounced in women.