Impact Of Different Ventricular Rate Control Strategy On Heart Diastolic Function In Patients With Persistent Atrial Fibrillation

Objective:In recent years,scholars' research and understanding of atrial fibrillation(AF)has been increasing.The control of ventricular rate has become an important part of atrial fibrillation management.RACE ? study had demonstrated that there is no significant difference in the prognosis of patients with persistent atrial fibrillation,however,little is known about the effect of different ventricular rate control strategy on cardiac diastolic function is not clear.With the increasing understanding of heart failure,diastolic heart failure has become the most common heart failure in the population,and has attracted more and more attention,especially in patients with atrial fibrillation.The purpose of this study was to observe the effects of different ventricular rate controls on the diastolic function of patients with persistent atrial fibrillation?Method:125 persistent atrial fibrillation patients in Zhongshan Hospital Affiliated to Dalian University from September 2015 to December 2016 were involved in this study.120 patients were divided into high heart rate group(80bpm<HR<110bpm)and low heart rate group(HR = 80bpm)according to the average heart rate by dynamic electrocardiogram after standardization drug treatment.All patients need to follow up the ambulatory electrocardiogram in an outpatient clinic by fourth months and eighth months.If both of the average heart rate of ambulatory electrocardiogram were not up to the standard,patients will be excluded.If the average heart rate of electrocardiogram examination for twelfth months of hospitalization was not standard,patients will be excluded.The selected patients data collection including gender,age,height,weight,combined basic diseases(hypertension,diabetes,coronary heart disease,COPD),medication records,average heart rate of electrocardiogram:admission time,fourth months,eighth months,twelfth months.NT-proBNP were collected on admission and the twelfth months.(1)Using Simpson method to measure LVEF,it can reflect the change of the left ventricular systolic function.(2)E/e' is the indicator obtained from the mixed imaging in the four-chamber view of the heart combined with mitral valve pulse Doppler flow and the mitral annulus Doppler imaging,E wave is the early diastolic blood flow velocity across the mitral valve in the left ventricular,e' is the speed of early diastolic mitral annulus on TDI.(3)Using ultrasound to measure left ventricular end diameter(LVDD).The anteroposterior diameter was measured along the major axial section and the major diameter and transverse diameter of the left atrium in the four-chamber view.The LAVI was calculated with the formula(?/6)D1×D2×D3/(0.0061×height+0.0128×weight-0.1529).All the data were analyzed with the SPSS 21.0.The measurement data was described as themean ± standard deviation.The independent sample t-tests were used for the comparison of the normally distributed data.The paired sample t-tests were applied for the comparison of paired data.the Wilcoxon tests were applied for the comparison of non-normally distributed data.The count data were given ?2 tests or Fisher's exact tests.P<0.05 was considered as statistically significant.Results:1.The comparision of the two groups about gender,age,combined disease(hypertension,diabetes,coronary heart disease,COPD),NT-proBNP,LAD,LVDD,e'?E/e' and LAVI are without the statistic significance(P>0.05).2.There was no significant difference in the admission of LAD,LVDD,LVEF,e',and LAVI compared with twelfth months in high ventricular rate group(P>0.05).There were statistically significant difference between admission and twelfth months indicators including NT-proBNP(1036 ±647.1 vs 1327±378.5,P=0.001),E/e'(10.63±2.7vs15.63±1.6.P=0.003).3.There were no statistically significant difference between admission and twelfth months indicators including NT-proBNP,LAD,LVDD,LVEF,e',E/e',and LAVI in low ventricular rate group(P>0.05).4.The NT-proBNP and E/e' levels of the two groups were all increased after treatment of ventricular rate,but the NT-proBNP and E/e levels in the high ventricular rate group were significantly higher than those in the low ventricular rate group(P<0.05).There was no significant difference in the changes of LAD,LVDD,LVEF,e'and LAVI in the high ventricular rate group compared with the low ventricular rate group(P>0.05).Conclusion:In patients with persistent atrial fibrillation,lenient rate-control strategy has no significant effect on cardiac systolic function in the short term,but it will lead to the decrease of cardiac diastolic function.In clinical practice,we should strictly control the ventricular rate of patients with atrial fibrillation.