Assessment Of Fluid Retention In Patients With Paroxysmal And Long-Standing Persistent Types Of Atrial Fibrillation

Abstract

Determining fluid retention in circulatory system currently remains a challenge. The objective of our study was to determine the sensitivity of individual symptoms and signs of chronic heart failure (CHF) and echocardiographic criteria for detecting fluid retention in patients with atrial fibrillation and invasively measured elevated atrial pressure. Methods — We conducted a prospective study of adult patients with a history of cardiovascular disease (coronary artery disease or/and arterial hypertension in combination with atrial fibrillation [AF]) hospitalized for radiofrequency catheter ablation. All patients underwent expert ultrasound examination of the heart using Philips HD 15 and Philips iE33 devices, as well as invasive measurement of pressure in the left and right atria at rest (n=20). Results — The sensitivity of dyspnea in patients with paroxysmal AF and long-standing persistent AF was 44.4% and 90.9%, respectively. The sensitivity of the mean E/e' ratio in patients with paroxysmal AF and long-standing persistent AF was 22.2% and 18.1%, correspondingly. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm, only one patient (11.1%) in the group with paroxysmal AF and 54.5% of subjects in the group with a long-standing persistent AF type had two positive criteria. The sensitivity of lower limb edema was 0% in patients with paroxysmal AF and 57.1% in those with long-standing persistent AF. The sensitivity of IVC diameter >22 mm was 80% in patients with paroxysmal AF and 57.1% in the group with long-standing persistent AF. At the same time, the sensitivity of the IVC inspiratory collapse ≤50% was significantly lower in both groups: 60% in patients with paroxysmal AF and 42.9% in subjects with long-standing persistent AF. Conclusion — Clinical symptoms and signs of chronic heart failure (CHF), as well as echocardiographic parameters reflecting an increase in the filling pressure of the heart chambers, are characterized by extremely low sensitivity in a cohort of patients with paroxysmal AF. The use of more stringent criteria for diagnosing congestion in this group of patients leads to a significant underdiagnosis of elevated filling pressure in the left chambers of the heart, which, in turn, increases the likelihood of insufficient prescription of diuretic therapy when it is objectively necessary.