الفهرس 
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Abstract
NVAF and CAD are strongly related; as they share common risk factors and pathophysiology. Moreover patients with CAD are at high risk for developing AF, and the presence of AF in patients with acute coronary syndrome has worse outcome. Atrial and extensive ventricular ischemia can lead to developing AF. On the other hand AF and accelerated heart rate can lead to cardiac ischemia [155].
The aim of this study is to evaluate the epidemiological pattern, the coronary angiographic patterns, and the severity of CAD and the relation between CAD and NVAF in patients with nonvalvular AF (NVAF) in comparison with patients with sinus rhythm, presented to Sohag University Hospital Cath. Lab.
The study population was 224 patients presented to Sohag University Hospital Cath. Lab. from the first of January 2017 till the end of December 2020, divided into 2 groups; group 1: 112 patients with NVAF. NVAF is defined as: AF without moderate-to-severe mitral stenosis or a mechanical heart valve; as mentioned in the focused update of the 2019, (AHA/ACC)/HRS Guideline for the management of patients with AF) [29], and group 2: 112 Patients with sinus heart rhythm.
Patients with valvular AF (defined as: AF with moderate-to-severe mitral stenosis or a mechanical heart valve; as mentioned in the focused update of the 2019, (AHA/ACC)/HRS Guideline for the management of patients with AF [29] were excluded from the study.
Demographic data, risk factors of coronary artery disease, different presentations, echocardiographic and coronary angiographic findings of patients with NVAF were analyzed and compared with an equal number of patients with sinus rhythm.
Most of the patients in the two groups were 40- 65 years of age, Patients older than 65 years of age were slightly more in NVAF group. Men are more common in both groups, Hypertensive and diabetic patients were more common in sinus group ; this may be due to the large number of NVAF patients who were for preoperative assessment and the limited number of study population. Smokers were more in NVAF group. The heart rate was higher among patients in NVAF group. BMI was higher in the NVAF group. Chest pain was the most common presenting symptom in both groups.
All the patients in the NVAF group were between CHA2DS2VASc score 0 and 4, with score 2 representing is the most frequent score.
The ECG analysis of the patients revealed that ischemic changes and old MI were more in sinus group.
According to the echocardiographic findings suggesting ischemic heart disease was more in sinus group, and those suggesting rheumatic heart disease was more in NVAF group, cardiomyopathy was more in NVAF group, LVH was more in NVAF group, Most of the patients in NVAF group had diastolic dysfunction Most of the NVAF group had normal ejection fraction .Pulmonary hypertension was more in NVAF group. Left ventricular dilatation, left atrial dilatation right ventricular dilatation and right atrial dilatation were more in NVAF group.
The end diagnostic results of the coronary angiography revealed that the rate and severity of CAD were by more in sinus group; this may result from the increased risk factors, the presentation more with acute coronary syndrome, and consistence with the ECG and Echocardiographic findings.
There was no association between anatomical characteristics of CAD and NVAF, since the prevalence of AF in the study was independent of the distribution of coronary stenosis, this observation might decrease a higher risk of the developing AF in relation to stenosis in coronary arteries supplying the atria.
Regarding the CHA2DS2VASc score and its relation with the coronary angiographic results; there was no significant relation between the severities of CAD and CHA2DS2VASc score, also it is limited by the number of the study population but this point needs to be studied in a larger number of patients as it may be used as a risk score for CAD in patients with NVAF as well.
The etiological role of CAD in patients of NVAF is markedly reduced by the results of this study, and should be reassessed.
Conclusion:
Older age, Male gender, smoking and obesity are risk factors for CAD in NVAF patients. The rate and severity of CAD were more in sinus group; CAD <50% was (25%) of patients in sinus group and (22.3%) of those in NVAF group, CAD >50% was in (30.4%) of sinus group and (24.1%) of NVAF group, 2 vessel disease was found in (11.6%) of sinus group and in only (0.9%) of NVAF group, 3 vessel disease was found in (22.3%) of sinus group and in (8.9%) of NVAF group. CHA2DS2VASc score may be not a suitable indicator for CAD in patients with NVAF. CAD is not the main etiology of NVAF.
The etiological role of CAD in patients of NVAF is markedly under estimated by the results of this study, and should be reassessed.
Recommendations
A larger number of patients with NVAF patients should be studied, the possibility of the use of CHA2DS2VASc score for CAD risk assessment in NVAF patients, and the role of CAD as one of the main etiologies of NVAF should be reevaluated.
Limitations
The study was limited by the small number of study population.