A validation study to investigate the role of Central Hypertension in Atrial Fibrillation Outcome

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Central hypertension leading to early vascular remodelling is an independent predictor of major cardiovascular events. Aorta is not only a conduit artery but also act as a vascular buffer to each ventricle contraction. Overtime, this stretch leads to decrease aortic compliance resulting in aortic stiffness. Ageing and HTN are the predominant attributable risk factors leading to premature aortic stiffness. Central HTN can be computed by pulse wave morphology or velocity assessment. Central pressure indices including systolic, diastolic, pulse and augmented pressure along with augmentation index can be derived by central pulse wave morphology. Although evaluation of central haemodynamics can potentially flag the early phase of vascular remodelling but the precise component of central pressure indices predicting risk as per age is under considerable debate. Aortic stiffness is recognised as a surrogate for central arterial hypertension and its non-invasive estimation by pulse wave velocity (PWV) is considered “gold standard” by European Society of Cardiology (ESC) 2013 guidelines. Non-invasive central pulse wave morphology and velocity assessment is not being validated during atrial fibrillation (AF) . In addition, there is paucity of data revealing central pressure indices, including PWV appraisal as an independent predictor of outcome in AF. 1 Purpose of the study Raised central pressure is more closely associated with cardiovascular outcome as compare to peripheral HTN. There is evolving evidence that central HTN is underdiagnosed leading to inadequate treatment resulting in early vascular ageing. We propose a staged prospective investigation by designing two perspective studies to validate and incorporate central pressure indices (central systolic, diastolic and pulse pressure with augmentation index and PWV) respectively in AF risk stratification with a view to titrate treatment as per central pressure to study clinical outcome in AF. 2 Aims In this validation study we will compare invasive versus non-invasive central pressure indices appraisal including pulse wave morphology and velocity assessment in AF. Through this study we seek: I. To validate widely used non-invasive methods to assess local, regional and systemic central pressure indices while the subjects are in atrial fibrillation (AF). We will compare the non-invasive appraisal of central pressure with an invasive enumeration in our paroxysmal/persistent atrial fibrillation (PAF) cohort in atrial fibrillation and post restoration of sinus rhythm during elective pulmonary vein isolation (PVI). II. We will review the shift in central pressure profile with rhythm control in our PAF cohort to identify the early changes in central pulsatile load as well as conduit artery compliance with restoration of sinus rhythm. and will draw a comparison between invasive and non-invasive evaluation

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