Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes

M. Guazzi, S. Belletti, L. Lenatti, E. Bianco, M. D. Guazzi

Research output: Contribution to journalArticle

Abstract

Background: Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous. Materials and methods: Brachial artery flow-mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head-up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction. Results: After 2 weeks, CV in group 1 increased (P <0.01) supine FMD (from 7.22→9.50%) and restored its HUT potentiation (from 9.31→17.22%). In group 2, FMD also improved significantly with CV (supine from 4.92→7.11% and HUT from 5.29→11.83%; P <0.01). In group 3, CV did not promote significant FMD changes (supine from 5.12→4.92% and HUT from 4.98→4.73%). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm. Conclusions: Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.

Original languageEnglish
Pages (from-to)26-34
Number of pages9
JournalEuropean Journal of Clinical Investigation
Volume37
Issue number1
DOIs
Publication statusPublished - Jan 2007

Fingerprint

Electric Countershock
Medical problems
Atrial Fibrillation
Hypertension
Dilatation
Head
Shear stress
Comorbidity
Modulation
Brachial Artery
Vasoconstriction
Vasodilation
Type 2 Diabetes Mellitus
Recurrence

Keywords

  • Arrhythmias
  • Diabetes
  • Endothelium
  • Hypertension

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes. / Guazzi, M.; Belletti, S.; Lenatti, L.; Bianco, E.; Guazzi, M. D.

In: European Journal of Clinical Investigation, Vol. 37, No. 1, 01.2007, p. 26-34.

Research output: Contribution to journalArticle

Guazzi, M. ; Belletti, S. ; Lenatti, L. ; Bianco, E. ; Guazzi, M. D. / Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes. In: European Journal of Clinical Investigation. 2007 ; Vol. 37, No. 1. pp. 26-34.
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abstract = "Background: Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous. Materials and methods: Brachial artery flow-mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head-up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction. Results: After 2 weeks, CV in group 1 increased (P <0.01) supine FMD (from 7.22→9.50{\%}) and restored its HUT potentiation (from 9.31→17.22{\%}). In group 2, FMD also improved significantly with CV (supine from 4.92→7.11{\%} and HUT from 5.29→11.83{\%}; P <0.01). In group 3, CV did not promote significant FMD changes (supine from 5.12→4.92{\%} and HUT from 4.98→4.73{\%}). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm. Conclusions: Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.",
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N2 - Background: Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous. Materials and methods: Brachial artery flow-mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head-up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction. Results: After 2 weeks, CV in group 1 increased (P <0.01) supine FMD (from 7.22→9.50%) and restored its HUT potentiation (from 9.31→17.22%). In group 2, FMD also improved significantly with CV (supine from 4.92→7.11% and HUT from 5.29→11.83%; P <0.01). In group 3, CV did not promote significant FMD changes (supine from 5.12→4.92% and HUT from 4.98→4.73%). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm. Conclusions: Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.

AB - Background: Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous. Materials and methods: Brachial artery flow-mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head-up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction. Results: After 2 weeks, CV in group 1 increased (P <0.01) supine FMD (from 7.22→9.50%) and restored its HUT potentiation (from 9.31→17.22%). In group 2, FMD also improved significantly with CV (supine from 4.92→7.11% and HUT from 5.29→11.83%; P <0.01). In group 3, CV did not promote significant FMD changes (supine from 5.12→4.92% and HUT from 4.98→4.73%). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm. Conclusions: Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.

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KW - Endothelium

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