title: Left Atrial Mechanical Function and Aortic Stiffness in Middle-aged Patients with the First Episode of Atrial Fibrillation.
abstract: BACKGROUND
  In the early stages of atrial remodeling, aortic stiffness might be an indication of an atrial myopathy, in particular, atrial fibrosis. This study aimed to investigate the association between left atrial (LA) mechanical function, assessed by two-dimensional speckle tracking echocardiography, and aortic stiffness in middle-aged patients with the first episode of nonvalvular atrial fibrillation (AF).
  
  
  METHODS
  This prospective study included 34 consecutive patients with the first episode of AF, who were admitted to Kartal Koşuyolu Research and Training Hospital between May 2013 and October 2015, and 31 age- and gender-matched healthy controls. During the 1 st month (mostly in the first 2 weeks) following their first admission, 34 patients underwent the first pulse wave measurements. Then, 21 patients were recalled for their second pulse wave measurement at 11.8 ± 6.0 months following their initial admission. Echocardiographic and pulse wave findings were compared between these 34 patients and 31 healthy controls. We also compared the pulse wave and echocardiographic findings between the first and second measurements in 21 patients.
  
  
  RESULTS
  Pulse wave analysis showed no significant differences between the AF patients and healthy controls with respect to PWV (10.2 ± 2.5 m/s vs. 9.7 ± 2.1 m/s; P = 0.370), augmentation pressure (9.6 ± 7.4 mmHg vs. 9.1 ± 5.7 mmHg; P = 0.740), and aortic pulse pressure (AoPP; 40.4 ± 14.0 mmHg vs. 42.1 ± 7.6 mmHg, P = 0.550). The first LA positive peak of strain was inversely related to the augmentation pressure (r = -0.30; P = 0.02) and aortic systolic pressure (r = -0.26, P = 0.04). Comparison between the two consecutive pulse wave measurements in 21 patients showed similar results, except for AoPP. In 21 patients, the AoPP at the second measurement (45.1 ± 14.1 mmHg) showed a significant increase compared with AoPP at the first measurement (39.0 ± 10.6 mmHg, P = 0.028), which was also higher than that of healthy controls (42.1 ± 7.6 mmHg, P = 0.000).
  
  
  CONCLUSIONS
  The association between aortic stiffness with reduced atrial strain and the key role of AoPP in the development of AF should be considered when treating nonvalvular AF patients with normal LA sizes.
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Alev
authors.initials: A
authors.lastname: Kilicgedik
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Ç Efe
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Ahmet S
authors.initials: AS
authors.lastname: Gürbüz
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Acar
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Mehmet F
authors.initials: MF
authors.lastname: Yılmaz
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Aslan
authors.initials: A
authors.lastname: Erdoğan
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Kahveci
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Izgi
authors.affiliation: Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, Kartal, Istanbul 34846, Turkey.
authors.forename: Cevat
authors.initials: C
authors.lastname: Kirma
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology; D064752:Atrial Remodeling / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D059289:Vascular Stiffness / Q000502:physiology*