Особенности структурного ремоделирования сердца при хронической фибрилляции предсердий на фоне ишемической болезни сердца с артериальной гипертензией

Abstract

To reveal the peculiarities of structural myocardial remodeling in patients with chronic atrial fibrillation (AF) against the background of chronic ischemic heart disease (CIHD) with arterial hypertension (AH). Two groups of patients with CIHD with AH were formed: 1st - against the background of chronic AF (n=44) and 2nd - without FP (n=100). Anthropometric, general clinical and echocardiographic data were evaluated. Left ventricular hypertrophy (LVH) was observed in all patients with FP and in 96% of patients without FP, the groups did not differ in types of LVH (u-test Mann-Whitney p=0.7489). In both groups dominated by concentric hypertrophy: in the 1st group of 22 (50%) and in the 2nd group - 51 (51%), Fisher's exact test p=1,0. The linear dimensions of both atria were larger in group 1: the ratio of the left atrium/body surface area (BSA) in group 1 was 2.7 [2.2; 3] cm/m2 versus 2.1 [1.8; 2.5] cm/m2 in group 2 (U-test p=0.000004); the attitude of the right atrium / BSA - in the 1st group and 2.9 [2,4; 3,2] cm/m2 vs 2.3 [2,2; 2,6] cm/m2 in the 2nd group (U-test p<0.0000001). The level of calculated systolic pulmonary artery pressure in patients with AF was higher than in control: 38 [32; 41] mm Hg. vs. 27 [24; 31] mm Hg. art. respectively (U-test p<0.0000001). A more severe stage of chronic heart failure (CHF) was diagnosed in patients of the 1st group (U-test p=0.0000001). In patients with combination like hibs and hypertension remodeling affects both the LV and the atrium. In the presence of AF in such patients, structural changes in atria are more significant. AF itself is a predictor of chf and can contribute to the progression of heart failure in patients with CIHD and AH.