cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2383cardio-281Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESДиастолическая дисфункция левого желудочка при эндоваскулярном лечении фибрилляции предсердий у больных с сохраненной фракцией изгнанияLeft ventricular diastolic dysfunction in endovascular treatment of atrial fibrillation in patients with preserved ejection fractionБаймукановА. М.BaymukanovA. M.noemail@neicon.ruГендлинГ. Е.GendlinG. E.noemail@neicon.ruНикитинИ. Г.NikitinI. G.noemail@neicon.ruХамнагадаевИ. А.KhamnagadaevI. A.noemail@neicon.ruТермосесовС. А.TermosesovS. A.noemail@neicon.ruИльичИ. А.IljichI. L.noemail@neicon.ruФГБОУ ВО «РНИМУ им. Н. И. Пирогова» МЗ РФРоссияPirogov Russian National Research Medical UniversityRussian FederationГБУЗ «ГКБ им. В. М. Буянова» ДЗМРоссияV. M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare DepartmentRussian Federation201720112018572S331336Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/281

Цель. Изучить распространенность диастолической дисфункции ЛЖ (ДДЛЖ) и оценить влияние катетерной изоляции легочных вен на диастолическую функцию ЛЖ у пациентов с пароксизмальной и персистирующей формой фибрилляции предсердий (ФП). Материалы и методы. Обследовано 109 пациентов, страдающих пароксизмальной (n=90; 82,6%), персистирующей (n=19; 17,4%) формой ФП, которым было выполнено 109 катетерных изоляций легочных вен. Больные были разделены на две группы, в зависимости от эффективности операции. Всем пациентам в день операции, через 6 и 12 месяцев выполнялось ультразвуковое исследование сердца, в том числе включавшее в себя оценку диастолической функции ЛЖ. Результаты. После операции 61 пациент - 56,5% больных удерживали синусовый ритм (СР) в течение 12 месяцев и составили Группу I. Группа II: больные с рецидивом ФП (47 человек; 43,5%). На старте исследования ДДЛЖ на фоне СР была зафиксирована у 53 больных (48,6%), через 6 месяцев - у 34 (31,2%) (p=0,001), через 12 месяцев - у 27 пациентов (24,8%) (p<0,001). В группе I отмечено статистически значимое увеличение скорости раннего наполнения ЛЖ (пик Е) (p<0,001); зафиксирована нормализация соотношения Е/А (p<0,001); выявлено увеличение скорости движения септальной (e' septal) (p=0,001) и латеральной (e' lateral) (p=0,03) части фиброзного кольца митрального клапана. В группе пациентов с рецидивами ФП подобных изменений параметров не произошло. Увеличение скорости пика Е через 12 месяцев после операции продемонстрировало статистически значимое влияние на отсутствие рецидива ФП (p=0,021). Заключение. Выявлено, что приблизительно у половины пациентов, страдающих пароксизмальной или персистирующей формой ФП, выявляется ДДЛЖ. У пациентов, длительно сохраняющих СР после катетерной изоляции легочных вен, происходит нормализация показателей диастолической функции ЛЖ.

Aim. To study prevalence of left ventricular diastolic dysfunction (LVDD) and to evaluate the effect of pulmonary vein catheter isolation on left ventricular (LV) diastolic function in patients with paroxysmal and persistent forms of atrial fibrillation (AF). Materials and methods. 109 patients with paroxysmal (n=90; 82.6%) and persistent (n=19; 17.4%) AF were evaluated after 109 pulmonary vein catheter isolations. The patients were divided into two groups based on the operation efficacy. Heart ultrasound including evaluation of the LV diastolic function was performed for all patients on the day of operation and at 6 and 12 months. Results. After the surgery, 61 (56.5%) patients maintained sinus rhythm (SR) for 12 months and comprised Group 1. Group 2 consisted of patients with a relapse of AF (47 patients; 43.5%). At baseline, LVDD with SR was observed in 53 patients (48.6%), at 6 months - in 34 (31.2%) patients (p=0.001), and at 12 months - in 27 patients (24.8%) (p<0.001). In Group 1, the early LV filling velocity (peak E) was statistically significantly increased (p<0.001); the E/A ratio recovered (p<0.001); and mitral septal (e’ septal) (p=0.001) and lateral (e’ lateral) (p=0.03) annulus motion velocities were increased. Such changes in parameters did not occur in the group of patients with a relapse of AF. The increased velocity of peak E at 12 months of surgery statistically significantly influenced the absence of AF relapse (p=0.021). Conclusion. Approximately a half of patients with paroxysmal or persistent AF had LVDD. In patients who maintained SR following pulmonary vein catheter isolation, parameters of LV diastolic function recovered.

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