title: Endothelial cell function during atrial fibrillation and after restoration of sinus rhythm.
abstract: Beat-to-beat variation in blood flow dynamics during atrial fibrillation (AF) has been associated with evidence of endothelial dysfunction. The aim of the present work is to confirm endothelial dysfunction in patients with AF and test the hypothesis that endothelial dysfunction is reversible upon restoration of normal sinus rhythm. Endothelium-dependent (flow-mediated dilation [FMD]) and endothelium-independent (nitroglycerin-mediated dilation [NMD]) vasodilator function of the brachial artery were measured using high-resolution ultrasound in 46 patients with persistent AF who were scheduled for internal electrical cardioversion and in 25 control subjects. In patients who remained in sinus rhythm after cardioversion, these measurements were repeated after 24 hours (n = 32) and 1 month (n = 19). Compared with control subjects, patients (n = 32) showed lower FMD during AF (8.1 +/- 3.6% vs 12.2 +/- 3.2%, respectively, p <0.001) and similar NMD (17.0 +/- 3.5% vs 15.9 +/- 3.1%, respectively, p = 0.21). In 19 patients who remained in sinus rhythm, FMD increased at both 24 hours (8.0 +/- 3.9% vs 10.6 +/- 4.6%, p = 0.015) and 1 month (8.0 +/- 3.9% vs 13.6 +/- 5.3%, p <0.001). In contrast, NMD was not significantly altered at 24 hours or 1 month after sinus rhythm restoration (17.1 +/- 3.9% vs 17.2 +/- 4.0% vs 16.9 +/- 4.1%). In conclusion, AF is associated with impairment in endothelial function that improves after sinus rhythm restoration.
authors.affiliation: Cardiology Department, University Hospital of Heraklion, Crete, Greece.
authors.forename: Emmanuel I
authors.initials: EI
authors.lastname: Skalidis
authors.forename: Evangelos A
authors.initials: EA
authors.lastname: Zacharis
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Tsetis
authors.forename: Kostas
authors.initials: K
authors.lastname: Pagonidis
authors.forename: Gregory
authors.initials: G
authors.lastname: Chlouverakis
authors.forename: Spyridon
authors.initials: S
authors.lastname: Yarmenitis
authors.forename: Michalis
authors.initials: M
authors.lastname: Hamilos
authors.forename: Emmanuel G
authors.initials: EG
authors.lastname: Manios
authors.forename: Panos E
authors.initials: PE
authors.lastname: Vardas
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004554:Electric Countershock; D004562:Electrocardiography; D042783:Endothelial Cells / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*