IMPACT OF SEX ON THE ASSOCIATION BETWEEN AORTIC WAVE REFLECTION AND LEFT ATRIAL FUNCTION IN HYPERTENSIVE PATIENTS WITH RECURRENT ATRIAL FIBRILLATION

Objective: Hypertension is the leading cause of atrial fibrillation (AF). However, the exact mechanism of the relation between high blood pressure and arrhythmia is still incompletely understood. Although the systolic loading sequence likely affects ventriculoatrial coupling, the data concerning the relationship between central aortic pressure and left atrial (LA) function including depending on sex is scarce. Purpose: To assess the impact of sex on the association between aortic wave reflection parameters and LA function in patients with AF and hypertension. Design and method: 45 men and 46 women with paroxysmal or persistent AF and hypertension were enrolled in the study. The parameters of LA size and function included in our analyses were: LA minimum volume (LAVmin), LA maximum volume (LAVmax), LA emptying fraction (LAEF), and LA expansion index (LAEI). The parameters of central aortic pressure were estimated using applanation tonometry method. All patients had sinus rhythm at the time of the study. Results: There were no significant differences between men and women in most clinical and demographic parameters. Both groups had similar LV mass index, but women had worse diastolic function (E/E’: 7.1 vs 9,8; p<0.001). Men and women had similar LAVmax index, however, women had worse LAEF (49 vs 39%; p=0.004) and LAEI (98 vs 64%; p=0.02). Despite similar central systolic, diastolic pressure and pulse wave velocity, women had higher aortic augmentation index (Aix) [33 vs 25%; p<0.001], even adjusted by HR (Aix75) [34 vs 26%; p<0.001]. In a multivariate regression analysis, in men LAEF was significantly associated with height (p=0.02), weight (p=0.046), E’ (p<0.001), and E/E’ (p<0.001), whereas in women with E’ (p=0.003) and Aix75 (p=0.04), and GFR (p=0.02). Conclusions: Patients of both genders had similar structural patterns of LA remodeling, but women characterized by more impaired LA function parameters. As according to previous reports, women had higher wave reflection parameters (Aix and Aix75). In multiple regression analysis, only in women did LAEF significantly relate to Aix75. It might indicate a higher susceptibility of the women's LA to increased hemodynamic overload caused by wave reflection.