Doctoral defence: Priit Pauklin „Hemodynamic and Biochemical Characteristics of Patients with Atrial Fibrillation and Anticoagulation of ≥65-year-old Patients with Atrial Fibrillation in Estonia”

On December 8th Priit Pauklin will defend his thesis „Hemodynamic and Biochemical Characteristics of Patients with Atrial Fibrillation and Anticoagulation of ≥65-year-old Patients with Atrial Fibrillation in Estonia“.

Supervisoris:
Associate professor Priit Kampus, University of Tartu
Professor Jaan Eha, University of Tartu

Opponent:
Associate professor Peter M Nilsson, Lund University, University Hospital Malmö (Sweden)

Summary:

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, affecting 2-4% of the adult population. This arrhythmia significantly impairs the patient's quality of life and increases the risk of stroke by up to 5 times. Several risk factors for this arrhythmia are known, such as hypertension, diabetes, sleep apnea, and obesity. However, the complete pathophysiological and hemodynamic mechanisms related to this arrhythmia are not yet fully understood. Since a heightened risk of stroke is present in most patients ≥65 years old, continuous anticoagulant therapy is necessary for thrombus prevention. While studies globally have indicated underutilization of anticoagulant therapy, specific data for Estonia is lacking. In this doctoral thesis, both indicators related to the hemodynamics of blood pressure and biomarkers associated with inflammation, oxidative stress, and fibrosis were examined in AF patients and a control group. In addition to blood tests, hemodynamics of blood pressure were measured in patients with arrhythmias to assess changes related to central blood pressure and arterial stiffness. Patients were monitored for 1 year for recurrence of arrhythmias. Furthermore, the nationwide use of continuous anticoagulant therapy among AF patients aged ≥65 was investigated, evaluating medication coverage based on prescribed daily doses. It was found that despite similar blood pressure measurements taken from the arm, patients with arrhythmias had higher central blood pressure and pulse wave velocity, indicating greater arterial stiffness. Study participants exhibited higher levels of myeloperoxidase, high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and galectin-3. Elevated myeloperoxidase levels were associated with a higher risk of AF recurrence. The utilization of continuous anticoagulant therapy in Estonia is extremely low, with only 57.4% of the studied patients in 2019 and 44.5% in 2020 achieving ≥80% coverage based on issued anticoagulant therapy prescriptions.

Watch defence via Teams.