Asymmetric dimethylarginine is associated with the phenomenon of coronary slow flow in patients with nonvalvular atrial fibrillation

Objective: Coronary slow flow phenomena (CSFP) is associated with endothelial and blood component abnormalities in coronary arteries. Asymmetric dimethylarginine (ADMA) can damage the endothelium of the heart or blood vessels in patients with non-valvular atrial fibrillation (NVAF), causing changes in biological medium content. The factors related to the occurrence of CSFP in NVAF patients are currently unknown. Our aim is to analyze the relationship between ADMA and CSFP in NVAF patients.

Methods: We consecutively enrolled 134 patients diagnosed with NVAF and underwent coronary angiography, 50 control patients without a history of atrial fibrillation and with normal coronary angiographic flow were included at the same time. Based on the corrected TIMI frame count (CTFC), the NVAF patients were categorized into two groups, CTFC≤27 frames and CTFC>27 frames. Plasma ADMA, p-seletion (p-sel), von Willebrand Factor (vWF), D-dimer (D-Di), fibrinogen activator inhibitor-1 (PAI-1) and nitric oxide (NO) were detected by ELISA in the different groups. We counted the general clinical data and analyzed the factors associated with the presence of CSFP on coronary angiography in NVAF patients.

Results: We found that plasma ADMA levels were significantly higher among NVAF patients in the CTFC >27 grade group compared with the control or CTFC ≤27 group. In addition, the levels of blood cells and endothelium-related biomarkers (NO, p-seletion, vWF, D-Di, and PAI-1) were significantly altered and correlated with ADMA levels. Multifactorial analysis showed that plasma ADMA [OR (95%CI): 1.65 (1.21-2.43), p<0.001] and left atrial internal diameter [OR (95%CI): 1.04 (1.02, 1.1), p<0.001] could be used as independent risk factors for the development of CSFP in patients with NVAF. The ROC curves of ADMA can predict the development of CSFP in NVAF patients. The minimum diagnostic concentration for the development of CSFP in patients was 2.31 µmol/L.

Conclusion: Our study suggests that the high levels of ADMA and left atrial internal diameter in vivo in patients with NVAF can contribute to the development of CSFP. Therefore, aggressive preoperative detection and evaluation of ADMA and left atrial internal diameter can help to deal with the intraoperative presence of CSFP.