Arterial stiffness is associated with increased symptom burden in patients with atrial fibrillation

Abstract Background Increased arterial stiffness (AS) has been described as a predictor of atrial fibrillation (AF). This study was performed to assess whether increased AS leads to a higher symptom burden in patients with AF. Methods 162 consecutive patients (104 male, 58 female) with diagnosed AF (paroxysmal or persistent) were enrolled. Symptoms most likely attributable to AF were quantified according to the Canadian Cardiovascular Society (CCS) Severity of Atrial Fibrillation (SAF) scale. AS indices (aortic distensibility (AD), cyclic circumferential strain and aortic compliance) were characterized by transoesophageal echocardiography. Results The cohort was divided into asymptomatic to oligosymptomatic (SAF scale 0-1, n=78, 48.1%) and symptomatic (SAF scale ≥ 2, n=84, 51.9%) patients. Symptomatic patients tended to be younger (75 (67; 80) vs 71 (65; 79), p=0.047) and were more likely to be female (22 (28.2%) vs 36 (42.9%), p=0.052). Hypertension was more frequent in symptomatic patients. Aortic compliance indices each were reduced in symptomatic patients, most pronounced for aortic compliance ((cm/mmHg) 0.05 (0.03; 0.06) vs 0.04 (0.03; 0.05), p=0.01) followed by cyclic circumferential strain (0.09 (0.07; 0.11) vs 0.07 (0.04; 0.10), p=0.02) and AD ((10-3mmHg-1) 1.74 (1.34; 2.24) vs 1.54 (1.12; 2.08), p=0.03). Multivariable analysis revealed aortic compliance as independent predictor for symptoms in patients with AF with an OR of 2.6 (95%CI 1.2 to 3.4, p=0.003). Conclusions AS contributes to a high symptom burden in patients with AF, emphasizing the prognostic role of AS in the early detection and prevention in patients with AF.