Vol 16, No 6 (2020)

Endothelial dysfunction in patients with lone atrial fibrillation

Kiyan Heshmat-Ghahdarijani, Shahrzad Jangjoo, Afshin Amirpoor, Jamshid Najafian, Alireza Khosravi, Maryam Heidarpour, Mostafa Hekmat, Davood Shafie

DOI: http://dx.doi.org/10.22122/arya.v16i5.2095


BACKGROUND: Atrial fibrillation (AF) is the most common tachyarrhythmia in patients with cardiovascular diseases (CVDs) and may have significant complications such as stroke. The present study aims to evaluate endothelial dysfunction in patients with lone atrial fibrillation (LAF) through flow-mediated dilation (FMD) in the brachial artery, as a non-invasive method for evaluating functional and structural markers of endothelial dysfunction.

METHODS: In this case-control study, 43 patients with LAF were selected. 51 age and
sex-matched healthy individuals were selected as the control group. The brachial artery diameter of the subjects in both groups was measured through FMD. The obtained data were analyzed by SPSS software.

RESULTS: Patients with LAF and healthy subjects did not have any difference in terms of gender, heart rate (HR), and systolic blood pressure (SBP) (P > 0.05 for all). FMD of the patients with AF was significantly lower (P = 0.04) than FMD of the healthy controls.

CONCLUSION: Our findings showed that LAF was associated with systemic endothelial dysfunction. AF plays an important and independent role in reducing FMD.



Atrial Fibrillation; Arrhythmia; Dysfunction

Full Text:



Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14(4): 528-606.

Davis RC, Hobbs FD, Kenkre JE, Roalfe AK, Iles R, Lip GY, et al. Prevalence of atrial fibrillation in the general population and in high-risk groups: The ECHOES study. Europace 2012; 14(11): 1553-9.

Shen AY, Contreras R, Sobnosky S, Shah AI, Ichiuji AM, Jorgensen MB, et al. Racial/ethnic differences in the prevalence of atrial fibrillation among older adults-a cross-sectional study. J Natl Med Assoc 2010; 102(10): 906-13.

Savelieva I, Kourliouros A, Camm J. Primary and secondary prevention of atrial fibrillation with statins and polyunsaturated fatty acids: Review of evidence and clinical relevance. Naunyn Schmiedebergs Arch Pharmacol 2010; 381(3): 1-13.

Friberg J, Buch P, Scharling H, Gadsbphioll N, Jensen GB. Rising rates of hospital admissions for atrial fibrillation. Epidemiology 2003; 14(6): 666-72.

Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. Braunwald's heart disease e-book: A textbook of cardiovascular medicine. Philadelphia, PA: Elsevier Health Sciences; 2018.

Nguyen TN, Hilmer SN, Cumming RG. Review of epidemiology and management of atrial fibrillation in developing countries. Int J Cardiol 2013; 167(6): 2412-20.

Cines DB, Pollak ES, Buck CA, Loscalzo J, Zimmerman GA, McEver RP, et al. Endothelial cells in physiology and in the pathophysiology of vascular disorders. Blood 1998; 91(10): 3527-61.

Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: A marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol 2003; 23(2): 168-75.

Heshmat-Ghahdarijani K, Javanmard SH, Sonbolestan SA, Saadatnia M, Sonbolestan SA. Endothelial function in patients with migraine without aura during the interictal period. Int J Prev Med 2015; 6: 2.

Pober JS, Min W. Endothelial cell dysfunction, injury and death. Handb Exp Pharmacol 2006; (176 Pt 2): 135-56.

Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: Testing and clinical relevance. Circulation 2007; 115(10): 1285-95.

Goligorsky MS. Clinical assessment of endothelial dysfunction: Combine and rule. Curr Opin Nephrol Hypertens 2006; 15(6): 617-24.

Yang Z, Ming XF. Recent advances in understanding endothelial dysfunction in atherosclerosis. Clin Med Res 2006; 4(1): 53-65.

Esper RJ, Nordaby RA, Vilarino JO, Paragano A, Cacharron JL, Machado RA. Endothelial dysfunction: A comprehensive appraisal. Cardiovasc Diabetol 2006; 5: 4.

Takahashi N, Ishibashi Y, Shimada T, Sakane T, Ohata S, Sugamori T, et al. Atrial fibrillation impairs endothelial function of forearm vessels in humans. J Card Fail 2001; 7(1): 45-54.

Shin SY, Na JO, Lim HE, Choi CU, Choi JI, Kim SH, et al. Improved endothelial function in patients with atrial fibrillation through maintenance of sinus rhythm by successful catheter ablation. J Cardiovasc Electrophysiol 2011; 22(4): 376-82.

Guazzi M, Belletti S, Bianco E, Lenatti L, Guazzi MD. Endothelial dysfunction and exercise performance in lone atrial fibrillation or associated with hypertension or diabetes: Different results with cardioversion. Am J Physiol Heart Circ Physiol 2006; 291(2): H921-H928.

Guazzi M, Belletti S, Lenatti L, Bianco E, Guazzi MD. Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes. Eur J Clin Invest 2007; 37(1): 26-34.

Skalidis EI, Zacharis EA, Tsetis DK, Pagonidis K, Chlouverakis G, Yarmenitis S, et al. Endothelial cell function during atrial fibrillation and after restoration of sinus rhythm. Am J Cardiol 2007; 99(9): 1258-62.

Polovina M, Potpara T, Giga V, Stepanovic J, Ostojic M. Impaired endothelial function in lone atrial fibrillation. Vojnosanit Pregl 2013; 70(10): 908-14.

Freestone B, Chong AY, Nuttall S, Lip GY. Impaired flow mediated dilatation as evidence of endothelial dysfunction in chronic atrial fibrillation: Relationship to plasma von Willebrand factor and soluble E-selectin levels. Thromb Res 2008; 122(1): 85-90.

Cai H, Li Z, Goette A, Mera F, Honeycutt C, Feterik K, et al. Downregulation of endocardial nitric oxide synthase expression and nitric oxide production in atrial fibrillation: Potential mechanisms for atrial thrombosis and stroke. Circulation 2002; 106(22): 2854-8.

Minamino T, Kitakaze M, Sato H, Asanuma H, Funaya H, Koretsune Y, et al. Plasma levels of nitrite/nitrate and platelet cGMP levels are decreased in patients with atrial fibrillation. Arterioscler Thromb Vasc Biol 1997; 17(11): 3191-5.

Guazzi M, Arena R. Endothelial dysfunction and pathophysiological correlates in atrial fibrillation. Heart 2009; 95(2): 102-6.

Wachtell K, Lehto M, Gerdts E, Olsen MH, Hornestam B, Dahlof B, et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: The losartan intervention for end point reduction in hypertension (LIFE) study. J Am Coll Cardiol 2005; 45(5): 712-9.

Parthenakis FI, Patrianakos AP, Skalidis EI, Diakakis GF, Zacharis EA, Chlouverakis G, et al. Atrial fibrillation is associated with increased neurohumoral activation and reduced exercise tolerance in patients with non-ischemic dilated cardiomyopathy. Int J Cardiol 2007; 118(2): 206-14.

Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006; 27(2): 136-49.

Kim YM, Guzik TJ, Zhang YH, Zhang MH, Kattach H, Ratnatunga C, et al. A myocardial Nox2 containing NAD(P)H oxidase contributes to oxidative stress in human atrial fibrillation. Circ Res 2005; 97(7): 629-36.

Lin YK, Lu YY, Chen YC, Chen YJ, Chen SA. Nitroprusside modulates pulmonary vein arrhythmogenic activity. J Biomed Sci 2010; 17(1): 20.

Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108(24): 3006-10.

O'Neal WT, Efird JT, Yeboah J, Nazarian S, Alonso A, Heckbert SR, et al. Brachial flow-mediated dilation and incident atrial fibrillation: The multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol 2014; 34(12): 2717-20.

Weiner SD, Ahmed HN, Jin Z, Cushman M, Herrington DM, Nelson JC, et al. Systemic inflammation and brachial artery endothelial function in the Multi-Ethnic Study of Atherosclerosis (MESA). Heart 2014; 100(11): 862-6.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.