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Research ArticleOriginal Article
Open Access

Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation

Jing Zhang, Qiang Tan, Wang Lina and Zhang Zhaoqian
Saudi Medical Journal July 2022, 43 (7) 708-714; DOI: https://doi.org/10.15537/smj.2022.43.7.20220214
Jing Zhang
From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China.
MD, PhD
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Qiang Tan
From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China.
MD, PhD
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  • For correspondence: [email protected]
Wang Lina
From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China.
MD
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Zhang Zhaoqian
From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China.
MD
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Article Figures & Data

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  • Figure 1
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    Figure 1

    - Kaplan-Meier analysis for composite event free survival in both groups. FMD: flow-mediated dilatation

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    Figure 2

    - Kaplan-Meier analysis for heart failure rate in both groups. FMD: flow-mediated dilatation

  • Figure 3
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    Figure 3

    - Kaplan-Meier analysis for stroke in both groups. FMD: flow-mediated dilatation

Tables

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    Table 1

    - Clinical characteristics in the 2 groups.

    CharacteristicsLow FMD (n=97)High FMD (n=194)P-value
    Age70.14±10.5264.14±11.010.000
    Gender (M/F)66/31131/630.929
    Smoking27620.472
    Diabetes26690.133
    Hypertension32710.544
    CHD29570.928
    CHA2DS2-VASc score3.19±0.972.33±0.900.000
    LVD (mm)51.53±7.2250.54±7.510.314
    LAD (mm)44.53±7.8142.27±7.620.019
    LVEF (%)59.42±12.2862.88±9.660.017
    TC (mmol/L)4.16±1.194.27±1.060.472
    TG (mmol/L)1.43±0.901.68±1.640.117
    LDL-C (mmol/L)2.39±0.912.52±0.830.220
    HDL-C (mmol/L)1.06±0.281.07±0.260.869
    Glucose (mmol/L)6.17±1.855.85±1.790.193
    Creatinine (µmol/L)85.03±43.2178.52±37.750.221
    Homocysteine (mmol/L)19.37±9.9516.54±7.790.021
    FMD (%)4.93±0.848.03±1.710.000
    Wafarin user33560.368
    NOAC user11220.584
    Beita blocker user721650.359
    Diuretics user11220.584
    ACEI/ARB user31620.389

    Values are presented as numbers (n) and mean ± standard deviatin (SD). FMD: flow-mediated dilatation, M: male, F: female, CHD: coronary artery disease, CHA2DS2-VASc: congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74, and gender category (female), LVD: left ventricular diameter, LAD: left atrial diameter, LVEF: left ventricular ejection fraction, TC: totol cholesterol, TG: triglyceride, LDL-C: low density lipoprotein-cholesterol, HDL-C: high-density lipoprotein cholesterol, NOAC: non-vitamin K antagonist oral anticoagulant, ACEI: angiotension converting enzyme inhibitors, ARB: angiotensin receptor blocker

      • View popup
      Table 2

      - Clinical outcomes in the 2 groups.

      VariablesLow FMD (n=97)High FMD (n=194)P-value
      Cardiovascular events36 (37.1)35 (18.0)0.000
      Heart failure19 (19.6)21 (10.8)0.041
      Nonfatal myocardial infarction4 (4.1)7 (3.6)0.826
      Cardiovascular death2 (2.0)4 (2.1)0.682
      Stroke11 (11.3)13 (6.7)0.175

      Values are presented as numbers and precentages (%) and analyses were carried out using χ2 statistics. FMD: flow-mediated dilatation

        • View popup
        Table 3

        - Cox proportional hazards model regression of composite cardiovascular events in patients with paroxysmal atrial fibrillation.

        CharacteristicsUnivariate analysisMultiple analysis
         hazard ratio (95% CI)P-valuehazard ratio (95% CI)P-value
        CHA2DS2-VASc score1.718 (1.357-2.175)0.0001.383 (1.035-1.847)0.028
        Low FMD3.371 (2.012-5.047)0.0003.036 (1.546-5.963)0.001
        LAD1.048 (1.022-1.073)0.0001.034 (1.001-1.069)0.041
        LVD1.027 (0.997-1.057)0.0760.979 (0.933-1.027)0.389
        LVEF0.983 (0.965-1.000)0.0500.995 (0.967-1.023)0.706
        Smoking1.138 (0.350-3.703)0.739------
        CHD0.841 (0.487-1.453)0.535------
        TC0.879 (0.680-1.136)0.323------
        TG0.844 (0.636-1.120)0.240------
        LDL-C0.948 (0.689-1.305)0.744------
        Creatinine1.044 (1.000-1.048)0.0381.001 (0.994-1.007)0.798
        Homocysteine1.045 (1.018-1.072)0.0011.029 (0.999-1.060)0.062
        Wafarin user0.883 (0.678-1.132)0.0360.913 (0.827-1.032)0.412
        NOAC user0.956 (0.577-1.038)0.116------
        Diuretics user1.031 (0.780-1.237)0.521------
        Beita blocker user0.912 (0.650-1.332)0.135------
        ACEI/ARB user1.002 (0.676-1.567)0.336------

        CI: confidence interval, CHA2DS2-VASc: congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74, and gender category (female), FMD: flow-mediated dilatation, LAD: left atrial diameter, LVD: left ventricular diameter, LVEF: left ventricular ejection fraction, CHD: coronary artery disease, TC: totol cholesterol, TG: triglyceride, LDL-C: low density lipoprotein-cholesterol, NOAC: non-vitamin K antagonist oral anticoagulant, ACEI: angiotension converting enzyme inhibitors, ARB: angiotensin receptor blocker

          • View popup
          Table 4

          - Cox proportional hazards model regression of heart failure in patients with paroxysmal atrial fibrillation.

          CharacteristicsUnivariate analysisMultiple analysis
          hazard ratio (95% CI)P-valuehazard ratio (95% CI)P-value
          CHA2DS2-VASc score1.214 (0.824-1.517)0.0861.204 (0.815-1.778)0.352
          Low FMD2.651 (1.411-4.980)0.0023.207 (1.320-7.7975)0.010
          LAD1.065 (1.037-1.093)0.0001.057 (1.022-1.093)0.001
          LVD1.040 (1.009-1.072)0.0120.965 (0.915-1.019)0.201
          LVEF0.978 (0.958-0.998)0.0280.992 (0.956-1.029)0.654
          Smoking1.148 (0.650-2.703)0.321------
          CHD1.166 (0.570-2.386)0.657------
          TC0.814 (0.584-1.133)0.212------
          TG0.822 (0.563-1.198)0.307------
          LDL-C1.024 (0.698-1.880)0.0491.038 (0.638-1.688)0.882
          Creatinine1.006 (1.0015-1.010)0.0091.002 (0.995-1.010)0.588
          Homocysteine1.071 (1.042-1.102)0.0001.048 (1.012-1.086)0.008
          Wafarin user0.893 (0.659-0.964)0.0450.897 (0.656-0.933)0.121
          NOAC user0.935 (0.571-1.038)0.139------
          Diuretics user1.131 (0.770-1.245)0.624------
          Beita blocker user0.952 (0.671-1.358)0.475------
          ACEI/ARB user0.836 (0.456-0.932)0.103------

          CI: confidence interval, CHA2DS2-VASc: congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74, and gender category (female), FMD: flow-mediated dilatation, LAD: left atrial diameter, LVD: left ventricular diameter, LVEF: left ventricular ejection fraction, CHD: coronary artery disease, TC: totol cholesterol, TG: triglyceride, LDL-C: low density lipoprotein-cholesterol, NOAC: non-vitamin K antagonist oral anticoagulant, ACEI: angiotension converting enzyme inhibitors, ARB: angiotensin receptor blocker

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          Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation
          Jing Zhang, Qiang Tan, Wang Lina, Zhang Zhaoqian
          Saudi Medical Journal Jul 2022, 43 (7) 708-714; DOI: 10.15537/smj.2022.43.7.20220214

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          Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation
          Jing Zhang, Qiang Tan, Wang Lina, Zhang Zhaoqian
          Saudi Medical Journal Jul 2022, 43 (7) 708-714; DOI: 10.15537/smj.2022.43.7.20220214
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          Keywords

          • paroxysmal atrial fibrillation
          • endothelial function
          • flow mediated dilation
          • heart failure
          • cardiovascular event

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