Note: AH is arterial hypertension; CAD is coronary artery disease; Type 2 DM means type 2 diabetes mellitus; AS is acute stroke; LAVI is the left atrial volume index; IVC is the inferior vena cava; TAPSE is tricuspid annular plane systolic excursion; Average Е/е’ is the ratio of the early-diastolic blood flow velocity to the average between the velocity of the lateral part and the medial part of the fibrous ring of the mitral valve.
Р indicates the significance of the differences between each group of patients and the control group; P’ indicates the significance of the differences between the group of patients with paroxysmal AF and the group of CHF patients without AF, and also the differences between the group of patients with permanent AF and the group of CHF patients without AF; P” indicates the significance of the differences between the group of patients with permanent AF and the group of patients with paroxysmal AF.
The patients with chronic heart failure, regardless of the absence or presence of paroxysmal or permanent atrial fibrillation, have structural changes in the heart, as compared to the control group, which were detected echocardiographically (P<0.05). These changes are as follows: myocardial hypertrophy of the walls of both ventricles (the LV inferolateral wall thickness is 11.20±0.20, 10.95±0.65, 11.50±0.64, and 7.73±0.16 mm, respectively; the interventricular septum thickness is 12.18±0.36, 12.11±0.80, 12.27±0.61, and 8.11±0.22 mm; the RV wall thickness is 7.95±0.76, 7.34±0.42, 8.88±1.29, and 4.22±0.72 mm), increased myocardial mass index (107.93±3.82, 108.63±7.62, 105.19±8.92, and 82.35±2.90 g/m2), dilatation of the right and left atria (the right atrium volume is 53.74±2.28, 54.14±5.23, 101.21±12.35, and 33.69±1.07 ml; the left atrium volume is 85.51±3.20, 103.41±10.63, 124.65±10.63, and 42.94±1.44 ml), LAVI (44.28±1.34, 58.81±5.92, 67.16±6.14, and 23.64±0.47), increased systolic pressure in the pulmonary artery (23.43±1.24, 26.05±3.25, 34.82±3.34 and 14.74±0.51 mm Hg), dilatation of the left lower pulmonary vein of the maximum (20.64±0.41, 22.21±0.69, 23.91±1.07, and 13.51±0.16 mm) and minimum (10.51±0.41, 13.15±1.07, 15.10±1.06, and 5.70±0.09 mm) diameters.
The patients with chronic heart failure having paroxysmal or permanent atrial fibrillation, as compared to patients without atrial fibrillation, have significantly more distinct structural changes in the heart. They are more evident left atrium dilatation (LA in the left lateral position is 41.26±1.49, 46.35±1.93, and 38.60±0.90 mm, respectively; left atrium volume is 103.41±10.63, 124.65±10.63, 85.51±3.20 ml; LAVI is 58.81±5.92, 67.16±6.14, and 44.28±1.34), dilatation of the left lower pulmonary vein of the maximum (22.21±0.69, 23.91±1.07, and 20.64±0.41 mm) and minimum (13.15±1.07, 15.10±1.06, and 10.51±0.41 mm,) diameters (Table 1).
Differences in myocardial remodeling in the patients with different forms of atrial fibrillation have been detected. The patients with permanent AF, as compared to the patients with paroxysmal AF, are noted to have larger LA dilatation (LA in the left lateral position is 46.35±1.93 vs. 41.26±1.49 mm; the left atrium volume is 124.65±10.63 vs. 103.41±10.63 ml; LAVI is 67.16±6.14 vs. 58.81±5.92) with larger dilatation of the left lower pulmonary vein of the maximum (23.91±1.07 vs. 22.21±0.69 mm) and minimum (15.10±1.06 vs. 13.15±1.07 mm) diameters with higher average E/e’ (14.78±1.45 vs. 11.34±1.81 mm). Besides, the dilatation of right atrium (the right atrium volume is 101.21±12.35 vs. 54.14±5.23 ml), more evident LV myocardial hypertrophy (LV inferolateral wall thickness is 8.88±1.29 vs. 7.34±0.42 mm), together with increased systolic pressure in the pulmonary artery (34.82±3.34 vs. 26.05±3.25 mm Hg) at a lower LV preserved ejection fraction (58.38±4.00 vs. 68.71±1.45%) and a decreased systolic function of the right ventricle (TAPSE is 16.50±1.42 vs. 21.40±1.04 mm), were detected in the CHF patients having permanent atrial fibrillation.