Clinical Significance of Peripheral Endothelial Function for Left Atrial Blood Stagnation in Nonvalvular Atrial Fibrillation Patients With Low-to-Intermediate Stroke Risk.
BACKGROUND
In patients who have atrial fibrillation (AF) with CHADS2score of 0-1 (categorized as low-to-intermediate risk), there is little information on stratifying the risk of stroke. This study aimed to determine whether impaired endothelial function assessed by reactive hyperemia-peripheral arterial tonometry (RH-PAT) predicted left atrial blood stagnation in these patients.


RESULTS
We enrolled 81 consecutive patients with nonvalvular AF. The reactive hyperemia index (RHI) was measured using RH-PAT. Transesophageal echocardiography was performed to determine spontaneous echo contrast (SEC) before direct-current cardioversion or radiofrequency catheter ablation. SEC was found in 49 patients (60%). The RHI was significantly lower in patients with than without SEC. Multivariate analysis demonstrated that RHI was one of the independent determinants of SEC (OR per 0.1, 1.26; 95% CI, 1.11-1.49; P=0.002) in all patients. In addition, RHI was a significant determinant of SEC (AUC, 0.73; 95% CI, 0.63-0.89; P=0.0017) in patients with low-to-intermediate risk. At an RHI cut-off <1.62, the sensitivity and specificity for the identification of patients with SEC were 58% and 89%, respectively.


CONCLUSIONS
Impaired endothelial function assessed by RH-PAT might help to predict the presence of SEC in patients with low-to-intermediate risk of stroke. (Circ J 2016; 80: 2117-2123).
Department of Cardiology, Pulmology, Hypertension and Nephrology, Ehime University Graduate School of Medicine.
Akira
A
Fujii
Katsuji
K
Inoue
Takayuki
T
Nagai
Teruyoshi
T
Uetani
Kazuhisa
K
Nishimura
Jun
J
Suzuki
Jun-Ichi
J
Funada
Takafumi
T
Okura
Jitsuo
J
Higaki
Akiyoshi
A
Ogimoto
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D017115:Catheter Ablation; D004554:Electric Countershock; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged