cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2024.3.n2466cardio-2466Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESОпределение риска развития пароксизма фибрилляции предсердий у пациентов с хронической сердечной недостаточностью с сохранной и сниженной фракцией выбросаDetermining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fractionhttps://orcid.org/0000-0002-5598-7952ЗахаровИ. П.ZakharovI. P.

аспирант кафедры кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (СеченовскийУниверситет).

Москва, Россия

Postgraduate Student at the Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

 

dr.nefro.zakhari@gmail.comhttps://orcid.org/0000-0003-1485-6072ЧомахидзеП. Ш.ChomakhidzeP. Sh.

д-р мед. наук, профессор кафедры кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет).

Москва, Россия

 

Dr. of Sci. (Medicine), Professor, Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

 

petr7747@gmail.comhttps://orcid.org/0000-0001-5124-6383КопыловФ. Ю.KopylovF. Yu.

д-р мед. наук, профессор кафедры кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет).

Москва, Россия

Dr. of Sci. (Medicine), Professor, Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

Kopylov_f_yu@staff.sechenov.ruhttps://orcid.org/0000-0003-1041-0292СултыговаЕ. А.SultygovaE. A.

аспирант кафедры кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет).

Москва, Россия

Postgraduate Student at the Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

 

 

sultygovaliza@gmail.comhttps://orcid.org/0000-0003-3541-6041МеситскаяД. Ф.MesitskayaD. F.

Кандидат медицинских наук, доцент кафедры кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет).

Москва, Россия

Candidate of Medical Sciences, Associate Professor, Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

aranid980@gmail.comhttps://orcid.org/0000-0003-3597-1379ЛюбимоваЕ. А.LyubimovaE. A.

студент 5 курса ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет).

Москва, Россия

Student, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

Stalkee@mail.ruhttps://orcid.org/0000-0002-0276-7374АндреевД. А.AndreevD. A.

д-р мед. наук, профессор кафедры кардиологии, функциональной и ультразвуковой диагностики ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет).

Москва, Россия

Dr. of Sci. (Medicine), Professor, Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russia

 

andreev_d_a@staff.sechenov.ruФГАОУ ВО Первый Московский Государственный Медицинский Университет имени И.М. Сеченова Минздрава РФ (Сеченовский Университет)РоссияSechenov First Moscow State Medical UniversityRussian Federation2024310320246432533Copyright © Kardiomag, 20242024KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2466

Цель. Определить предикторы развития фибрилляции предсердий (ФП) у пациентов с хронической сердечной недостаточностью (ХСН) с сохранной и сниженной фракцией выброса при помощи эхокардиографии (ЭхоКГ) по расширенному протоколу с определением диастолической функции и глобальной деформации миокарда левого предсердия.Материал и методы. Проведен анализ данных 168 пациентов с ХСН I–III стадии без ФП в анамнезе. Всем пациентам выполнена ЭхоКГ по расширенному протоколу с определением диастолической дисфункции (ДД), фракции выброса левого предсердия (ФВ ЛП) и глобальной деформации миокарда левого предсердия (ГДМ ЛП); методом тканевой допплерэхокардиографии (TDI) оценивали скорость раннего (Е) и предсердного (А) наполнения ЛЖ, а также скорость движения основания фиброзного кольца митрального клапана в раннюю диастолу (Е’) и предсердную фазу (А’). Всем пациентам проводилось мониторирование сердечного ритма методом Холтеровского мониторирования электрокардиограммы (ХМ ЭКГ) в течение 3 суток; наблюдение за параметрами ЭКГ средствами телемедицинских технологий в течение 7 дней 3 раза в день по 3 минуты. Срок наблюдения составил 3 месяца или до выявления эпизода ФП.Результаты. В ходе исследования у 41 (24,4 %) пациента выявлен пароксизм ФП (пФП) различными способами мониторирования сердечного ритма. Появление жалоб на ощущение сердцебиения было отмечено у 10 (24,4 %) пациентов при развитии пФП, что зафиксировано с помощью аппарата CardioQVARK®, ХМ ЭКГ или при записи ЭКГ в 12 отведениях. У 5 (12,2 %) пациентов при ежедневном контроле ЭКГ выявлен пФП без сопутствующих жалоб. С помощью ХМ ЭКГ за период 24, 48 и 72 часа выявлено 8, 2, 4 (19,5 %, 4,8 % и 9,7 %) случаев соответственно; при использовании одноканального аппарата CardioQVARK® 3 раза в сутки на протяжении 7 дней выявлены 30 (73,2 %) случаев. Данные результаты указывают на частое развитие ФП у пациентов с ХСН без сопутствующих симптомов. Способ выявления пФП при использовании аппарата CardioQVARK® показал хороший результат – в 2 раза эффективнее ХМ ЭКГ и в 3 раза эффективнее 12-канальной ЭКГ. Также по результатам ультразвукового исследования отмечены статистически значимые изменения показателей у пациентов с выявленной ФП: ФВ ЛП менее 36 % (ОШ 1,04, 95 % ДИ: 1,02–1,08), р=0,003; ГДМ ЛП менее 9,9 % (ОШ 1,16, 95 % ДИ: 1,02–1,38), р<0,001; TDI E med менее 5,7 см / с (ОШ 0,97, 95 % ДИ: 0,94–1,00), р=0,026. ДД 2‑й степени не показала статистически значимых результатов ОШ 1,1, 95 % ДИ: 0,7–1,5, р=0,54. Однако она выявлялась чаще у пациентов с ФП – в 34 % случаев, по сравнению с 29 % случаев у пациентов без ФП, что требует дальнейшего изучения с бóльшей выборкой пациентов.Заключение. У пациентов с ХСН риск развития пФП высокий – 24,4 %. Пациенты с ФП в 75 % случаев не чувствуют развитие пароксизма. Всем пациентам с ХСН необходимо проводить ЭхоКГ с оценкой ФВ ЛП, TDI E med и ГДМ ЛП для выявления группы риска по развитию ФП. Мониторирование сердечного ритма с помощью дистанционных аппаратов CardioQVARK® можно считать надежным методом для раннего выявления пФП и своевременного начала антикоагулянтной терапии у пациентов с ХСН.

Aim. To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain.Material and methods. Data of 168 patients with stage I–III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode.Results. During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7–1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample.Conclusion. Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

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The authors declare that there are no conflicts of interest present.