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.