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Guidelines for Endothelial Testing

Endothelial Dysfunction and AF

Eur J Clin Invest2021 Jan 16
Endothelial dysfunction and vascular maladaptation in atrial fibrillation
  • 1 Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, United Kingdom.
  • 2 Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
  • 3 Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi’an Shaanxi, China.
  • 4 Cardiovascular Prevention and Rehabilitation (EPIC) Center, Montreal Heart Institute, Montreal, Canada.
  • 5 School of Kinesiology and Exercise Science, Faculty of Medicine, Université de Montréal, Montreal, Canada.
  • 6 Department of Physiology, Radboudumc, Nijmegen, The Netherlands.
Atrial fibrillation (AF) is the most common arrhythmia and is associated with worsened morbidity and mortality. The prevalence of AF is estimated to increase with an ageing population resulting in an ever-increasing burden on the healthcare system. Despite improvements in AF treatment, several questions remain unanswered in relation to the development and progression of AF. In this review, we discuss the evidence supporting the presence of vascular dysfunction in the development of AF, but also as a final common pathway explaining why AF constitutes a markedly increased risk of cardiovascular morbidity and mortality. Specifically, we summarise the work performed in humans related to the impact of AF on vascular structure and function, and whether measures of vascular function predict AF progression and the development of cardiovascular events. Subsequently, we discuss the potential mechanisms linking AF to the development of vascular dysfunction. Finally, we propose future perspectives of vascular health and AF, advocating a strong focus on regular exercise training as a safe and effective strategy to improve vascular function and, hence, reduce the risk for development and progression of AF and its associated risk for cardiovascular events.
Keywords: atrial fibrillation; endothelial function; pathophysiology; risk factors; vascular health.
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