Effects of chronic airway obstruction and atrial fibrillation on the cardiac structure and function in patients with heart failure

Aim. To study the cardiac remodeling in heart failure (HF) patients with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD).

Material and methods. The study included 120 patients who were divided into 4 groups: the experimental group — patients with HF, AF and COPD (n=29), group 1 — patients with COPD, without cardiovascular disease (n=28), group 2 — patients with HF and COPD, without AF (n=30), group 3 — patients with HF and AF, without COPD (n=33). All patients underwent echocardiography using the MyLab70 Ultrasound System (Esaote, Italy).

Results. In comparison with patients of group 3, patients of the experimental group had lower left and right atrial volumes (p=0,001 and p=0,004, respectively), higher right ventricular (RV) wall thickness (p<0,001), lower RV end-diastolic area index (p=0,007) and fractional area change (FAC) (p=0б011), which indicates the effect of chronic airway obstruction on cardiac remodeling in patients with combination of these pathologies. In comparison with patients of group 2, patients of the experimental group had significantly larger RV dimension (p=0,012) and higher RV endsystolic area index (p<0,001), as well as lower systolic RV function (ejection fraction (p=0,002), FAC (p<0,001), tricuspid annular plane systolic excursion (p=0,012)) and higher pressure in the pulmonary circulation (p=0,001). This is due to high hemodynamic load on the RV related to AF and chronic airway obstruction.

Conclusion. The results of the study revealed features of cardiac remodeling pathogenesis in HF patients with AF and COPD. Comparative analysis of the results made it possible to indicate different mechanisms underlying AF, to assess the effects of both AF and chronic airway obstruction on the cardiac structure and function in patients with HF and combination of these pathologies.

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