#3897 STRUCTURAL AND FUNCTIONAL CHARACTERISTICS OF THE HEART IN ELDERLY AND OLD PATIENTS WITH CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION

Abstract

Abstract Background and Aims The study of cardiorenal relationships is an important area in medicine. The presence of chronic kidney disease (CKD) and atrial fibrillation (AF) in elderly and old patients requires a special integrated approach in diagnosis and treatment, taking into account the principles of patient orientation. The aim was to study of structural and functional characteristics of the heart in elderly and old patients with CKD and AF. Method 224 female and 215 male patients of elderly and old age (mean age 72.4±6.8 years) with AF were examined. Among elderly and old patients, the following types of AF were diagnosed: a permanent form was observed in 136 (30.9%), a persistent form - in 117 (26.7%), a long-term persistent form - in 98 (22.3%), a paroxysmal form - in 88 (20.1%). Glomerular filtration rate (GFR) was determined using the CKD-EPI equation. All patients underwent electrocardiography (ECG), echocardiography (EchoCG), and some patients underwent ECG monitoring by Holter with assessment of rhythm variability. Results CKD with GFR<60 ml/min/1.73m2 was diagnosed in 274 (62.4%) patients with AF: stage 3a – in 184 (67.2%), stage 3b – in 82 (29.9%), 4 stage - in 8 (2.9%) patients with CKD. When analyzing the structural and functional parameters of the heart, more than half of elderly and old patients with CKD had concentric left ventricular hypertrophy - 146 (53.3%), 65 (23.7%) patients had eccentric hypertrophy. The types of remodeling in elderly and old patients did not differ depending on the presence of CKD (p>0.05). The ejection fraction (EF) of the left ventricle in elderly and old patients did not differ depending on the presence of CKD (p = 0.5). Preserved left ventricular EF had 194 (70%) intermediate - 60 (21.7%), low - 23 (8.3%) elderly and old patients with CKD. In patients with AF and CKD, compared with patients without CKD, mitral regurgitation (p = 0.006) and aortic regurgitation (p = 0.02) were more frequently observed. Left atrial (LA) diameter, exceeding the norm, was observed in most patients regardless of the presence of CKD: in 191 (69.7%) patients with CKD and 118 (71.5%) without CKD (χ2 = 0.03, p = 0.86). Moderate and pronounced increase in LA diameter was observed in 111 (40.1%) patients with CKD and 63 (38.1%) without CKD (χ2 = 0.17, р = 0.67). When analyzing the LA index, an increase in size was observed significantly more often in patients with CKD than in patients without CKD: 79 (28.8%) and 25 (15.2%), respectively, χ2 = 10.75, p = 0.001. Enlargement of the right ventricle was detected in 94 (34.3%) patients with CKD and 53 (32.1%) without CKD (χ2 = 0.18, p = 0.67), right atrium – 35 (12.8%) patients with CKD and 19 (11.5%) without CKD (χ2 = 0.15, p = 0.7). Attention is drawn to the differences in the spectral analysis of the heart rate in elderly and old patients with CKD compared with patients without CKD: a higher index of centralization (0.55 (0.33-0.86) and 0.36 (0.25-0.48), respectively, p = 0.03) and a lower index of vagosympathetic interaction (1.48 (0.85- 2.32) and 3.16 (2.12- 4.59), p = 0.004). Conclusion When analyzing the structural and functional parameters of the heart in elderly and old patients with AF and CKD, there was an increase in the LА index, more frequent presence of mitral and aortic regurgitation compared to patients without CKD. Elderly and old patients with CKD had a lower index of vagosympathetic interaction compared to patients without CKD.