Thromboembolic risk factors and predictors of left atrial appendage thrombosis in Far North patients with nonvalvular atrial fibrillation

Aim. To analyze thromboembolic risk factors and identify additional predictors of left atrial appendage (LAA) thrombosis, which are not included in the CHA2DS2VASc scale, in long-term Far North residents with nonvalvular atrial fibrillation (AF).Material and methods. The study included 162 patients (men, 108; women, 54; mean age, 55,3±8,7 years) with non-valvular AF, living in the Far North, and 684 patients (men, 408; women, 276; mean age, 56,9±9,3 years), living in the temperate latitudes, hospitalized for catheter ablation. All patients underwent transthoracic and transesophageal echocardiography. According to transesophageal echocardiography, Far North patients were divided into two groups: group 1 — 21 patients with LAA thrombosis, group 2 — 141 patients without LAA thrombosis.Results. Compared to patients living in the temperate latitudes, Far North patients were younger (p=0,021) and were more likely to have type 2 diabetes (14,2% vs 8,3%, p=0,022), class ³II obesity (29,6% vs 21,1%, p=0,019), persistent AF(47,5% vs 33,2%, p=0,0019), LAA thrombosis (13% vs 6,6%, p=0,006), and severe structural and functional cardiac abnormalities (biatrial and right ventricular enlargement, lower left ventricular ejection fraction). In Far North patients, using logistic regression, independent predictors of LAA thrombosis were identified: an increase in left ventricular mass index (odds ratio (OR), 1,029; 95% confidence interval (CI), 1,011-1,048; p=0,001), persistent AF (OR, 3,521; 95% CI, 1,050-11,800; p=0,041).Conclusion. In Far North patients with nonvalvular AF, scheduled for catheter ablation, compared with patients from temperate latitudes, with a similar profile of cardiovascular diseases at a younger age, type 2 diabetes, grade ³II obesity, persistent AF, and LAA thrombosis were more common. The presence of persistent AF and an increase in left ventricular mass index are independent predictors of LAA thrombosis in Far North patients with nonvalvular AF

Assessment of the psycho-emotional state of patients after COVID-19-associated pneumonia in relationship with laboratory indicators

The aim. To study peculiarities and association of psychological and laboratory indicators in patients with cardiovascular diseases (CVD) who underwent COVID-19 to clarify the factors affecting the possibility of developing delayed psychological and cardiovascular adverse events.Methods. The study enrolled 350 patients with COVID-19. Group 1 consisted of 92 patients without CVD, Group 2 – of 258 patients with CVD. Indicators of laboratory and psychological parameters were assessed according to the data of psychological questionnaire using GAD-7 (General Anxiety Disorder-7), PHQ-9 (Patient Health Questionnaire-9), PSS (Perceived Stress Scale) screening scales and SF-36. Parameters of complete blood count and biochemical blood tests were measured during hospitalization and three months after discharge from the monohospital.Results. After three months, in the general group of patients, signs of anxiety and depression were detected in more than 30 % of the examined patients, signs of stress – in 10.4 %. In the group with CVD, psycho-emotional disorders were identified in 1/4 of the patients, and severe stress – in 8 % of those included in the study. In addition, it was registered that the indicators of erythrocyte sedimentation rate, fibrinogen, high-sensitivity C-reactive protein (CRP), homocysteine and IL-6 remained at a higher level in the second group.Correlation analysis showed that the psychological component of health is interconnected with the level of neutrophils (p = 0.044) and fibrinogen (p = 0.050); the physical component of health is correlated with the level of erythrocytes (p = 0.030), hemoglobin (p = 0.015), CRP (p = 0.002), creatine phosphokinase (p = 0.036) and glucose (p = 0.017). Regression analysis revealed that in patients with CVD three months after hospitalization, an increased glucose index contributes to deterioration, and increased hematocrit and mean hemoglobin concentration improve the quality of life of patients.Conclusion. Laboratory markers that maintain the duration of a prolonged vascular reaction, violation of the rheological and metabolic properties of blood, determine the nature of the development of both psychological and cardiovascular complications

Синдром обструктивного апноэ сна и фибрилляция предсердий: двунаправленная связь

Highlights. The data regarding the relationship between obstructive sleep apnea syndrome and atrial fibrillation were analyzed.Abstract. The review article presents current data on the relationship between obstructive sleep apnea syndrome and atrial fibrillation. The spread of these pathological processes increases with age and is associated with a significant risk of cardiovascular complications. In this regard, this review seems to be quite relevant. Possible pathophysiological mechanisms influencing the relationship between obstructive sleep apnea syndrome and atrial fibrillation are discussed. The role of CPAP therapy - Continuous Positive Airway Pressure in the prevention and treatment of atrial fibrillation is highlighted.Основные положения. Проанализированы и приведены данные о взаимосвязи синдрома обструктивного апноэ сна и фибрилляции предсердий.Резюме. В обзорной статье представлены современные данные о взаимосвязи синдрома обструктивного апноэ сна и фибрилляции предсердий. Распространение этих патологических процессов увеличивается с возрастом больных и сопряжено со значительным риском сердечно-сосудистых осложнений, что определяет актуальность представленной работы. Проанализированы возможные патофизиологические механизмы, влияющие на взаимосвязь синдрома обструктивного апноэ сна и фибрилляции предсердий. Освещена роль СИПАП-терапии (от англ. Continuous Positive Airway Pressure, СРАР) в профилактике и лечении фибрилляции предсердий

Синдром обструктивного апноэ сна и нарушения ритма сердца: современное состояние проблемы

The factors contributing to the development of cardiac arrhythmias in obstructive sleep apnea syndrome and the main methods of treating this syndrome have been analyzed and summarized.The review discusses the relationships of obstructive sleep apnea syndrome (OSAS) with various types of heart rhythm disorders. Pathogenetic factors of obstructive sleep apnea syndrome leading to the development of cardiac arrhythmias, current treatment strategies and their impact on heart rhythm disorders are summarized.Проанализированы и обобщены данные о факторах, способствующих развитию нарушений ритма сердца при синдроме обструктивного апноэ сна, и основных методах лечения синдрома.В обзоре представлен анализ современных данных о связи синдрома обструктивного апноэ сна с различными видами нарушений ритма сердца; патогенетических факторах синдрома, приводящих к развитию нарушений ритма сердца; существующих методах лечения обструктивного апноэ сна и их влиянии на нарушения ритма сердца

Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge

Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant.Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months±2 weeks after discharge from the hospital. The mean age of participants was 47±16 years (19-84 years); 49% of subjects were women.Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8±26,8 ml vs 93,5±29,4 ml; 37,7±13,0 ml vs 31,3±14,2 ml; 77,2±17,8 ml vs 62,2±18,7 ml, respectively, p<0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004; 21,7±3,6 mm vs 18,7±2,5 mm, p<0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] m><0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p<0,001) a><0,001) and maximum width (36,1±4,6 mm vs 34,5±6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7±6,8 mm vs 48,6±7,1 mm, p=0,021).Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load

Echocardiographic characteristics of COVID-19 pneumonia survivors three months after hospital discharge

Coronavirus disease 2019 (COVID-19) is an infectious disease that affects almost all organs and systems. The main target is the respiratory system, but cardiovascular involvement is also common. Today, it is relevant to study the effect of complicated COVID-19 course on the patient’s cardiovascular system after hospital discharge — in particular, echocardiographic parameters.Aim. To study the echocardiographic parameters of patients with COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients with documented COVID-19 pneumonia. Patients underwent a comprehensive examination during hospitalization and 3 months ± 2 weeks after hospital discharge. The mean age of participants was 47±16 years (from 19 to 84 years), while 49% were women.Results. Three months after discharge, the average body mass index of the subjects was 28,2±5,7 kg/m2. Obesity was noted in 37,1%, cardiovascular diseases — in 52%. According to echocardiography, the prevalence of right ventricular (RV) dilatation was 2,9%, a decrease in tricuspid annular plane systolic excursion (TAPSE) — 9,5%, grade ≥2 tricuspid regurgitation — 1,9%, pulmonary hypertension (pulmonary artery systolic pressure >36 mm Hg) — 3,8%. The mean value of RV global longitudinal myocardial strain (GLMS RV) and global longitudinal myocardial strain (GLES RV) was 19,6±4,5 and 20,6±4,6, respectively. We found moderate correlations between GLMS RV and blood flow time through the left ventricular outflow tract (OT) (r=-0,436), through the mitral valve (r=-0,390; both p<0,0001) and through the RVOT (r=-0,348; р=0,004), with cardiac index (CI) (r=0,316; p=0,009), as well as between GLES RV and blood flow time through the LVOT (r=-0,411; p<0,0001) and RVOT (r=-0,300; p=0,005), and with CI (r=0,302; p=0,004). At the same time, the correlation of GLES RV with RV fractional area change (FAC) was weak (r=-0,283; p=0,007), while there was no correlation with the TAPSE. In addition, correlation of GLMS RV with these parameters were not defined.Conclusion. Three months after COVID-19 pneumonia, RV strain parameters were shown to have stronger relationships with time characteristics of flows in LVOT and RVOT, as well as with CI, than with such generally accepted characteristics of RV function as FAC and TAPSE

The study of the dynamics of clinical and laboratory-instrumental parameters in hypertensive patients with obesity who underwent COVID-19-associated pneumonia

BACKGROUND: According  to the results of the ESSE-RF study, the frequency of obesity in the population  reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem.AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital.MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 — 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers — concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography  of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol; echocardiography using  an expert class ultrasound diagnostic  system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822.RESULTS: Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-α and NRL parameters in group 2 of patients with 2–3 degrees of obesity, may indicate the highest probability of developing  delayed adverse cardiovascular complications  in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly  higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium.CONCLUSION: Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium

Comparison of cardiovascular and psychological profile of young military men after COVID-19 with and without pneumonia

Aim. To compare the cardiovascular and psychological profile of young military population after coronavirus disease 2019 (COVID-19) with/without pneumonia. Material and methods. We examined 26 military men under 30 years of age (22,3±3,7 years/21,0 [19,8; 24,3] years) with documented COVID 19 (3 months±2 weeks after two virus-negative polymerase chain reaction tests). The participants were divided into 2 groups: experimental group (n=16) — those with COVID-19 pneumonia; comparison group (n=10) — those without pneumonia. All subjects underwent a complex of clinical and diagnostic tests. Results. Military men with COVID-19 pneumonia were significantly older (23,0 [20,5; 28,5] years vs 19,5 [19,0; 20,0] years, p=0,001). They had a prolonged PQ interval (154,5 [140,0; 163,5] ms vs 137,0 [134,0; 144,0] ms; p=0,014). According to echocardiography, the following parameters were significantly larger in experimental group: anteroposterior right ventricular dimension (26,0 [24,5; 27,5] mm vs 23,5 [22,0; 25,0] mm, p=0,012), right atrium length (48,0 [46,0; 51,5] mm and 45,5 [44,0; 47,0] mm, p=0,047), tricuspid regurgitation peak gradient (18,0 [15,5; 22,0] mm vs 14,0 [12,0; 20,0] mm, p=0,047), pulmonary artery systolic pressure (PASP) (30,3 [27,6; 34,0] mm Hg vs 23,0 [20,5; 30,5] mm Hg, p=0,038), mean pulmonary artery pressure (20,3 [18,9; 22,7] mm Hg vs 16,8 [14,5; 20,6] mm Hg, p=0,038). The estimated pulmonary vascular resistance was significantly higher in the study group (1,50 [1,2; 1,8] Wood units vs 1,17 [1,1; 1,2] Wood units,

CONTRAST ECHOCARDIOGRAPHY WITH ASSESSMENT OF MYOCARDIAL PERFUSION IN DIAGNOSIS OF NO-REFLOW PHENOMENON IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION

Timely performed endovascular revascularization is the main modern method of treating for patients with acute myocardial infarction and elevated ST segment. In most cases, it is possible to achieve rapid recovery of coronary blood flow in the infarct related artery. Nevertheless, 10–40 % of patients manifest diminished myocardial reperfusion despite successful opening of the obstructed epicardial artery – so called the no-reflow phenomenon. The main angiographic features of hypoperfusion in the infarction zone are decrease in the degree of myocardial glow and/or blood flow by the TIMI scale. However, the use of angiographic criteria does not always allow accurate detection of developing no-reflow phenomenon. The presented case demonstrates the possibilities and potential benefits of contrast enhanced echocardiography in assessing the no-reflow phenomenon in a patient with acute myocardial infarction after revascularization

Association of atrial fibrillation with coronary bed lesions (according to the coronary angiography register)

Aim. To identify the relationship of atrial fibrillation (AF) with features of lesions of the main coronary arteries or primary branches in patients with coronary artery disease (CAD).Material and methods. From the local database of coronary angiography, 6978 patients with hemodynamically significant (50% of the lumen and more) coronary lesions were selected. The main group consisted of 205 patients with AF. To create an age-matched comparison group, 810 patients without AF were selected from the remaining 6773 patients using a method based on equalizing the frequency distributions.Results. Patients with AF accounted for 2,9% of all patients with hemodynamically significant coronary stenosis. In patients with AF, obesity (56,6% vs 44,5%, p=0,002) and severe (III-IV) classes of chronic heart failure (CHF) according to NYHA classification (51,8% vs 22,8%, p<0,001) was more often detected. These patients had a higher mass index of the left ventricular (LV) (170,9±41,2 g/m2 vs 150,0±34,7 g/m2, p<0,001), higher size index of the right ventricle (RV) (13,8±2,1 mm/m2 vs 13,1±1,3 mm/m2, p<0,001); hemodynamically significant mitral (MR) (49,7% vs 15,9%, p<0,001) and aortic regurgitation (AR) (6,7% vs 1,5%, p<0,001) was also more often detected. Patients with AF more often had lesions of the right coronary artery (RCA) (90,2% vs 82,1%, p=0,005) and calcification of the coronary arteries (24,3% vs 14,8%, p=0,001), less often — the left type of coronary circulation (6,6% against 12,0%, p=0,029). According to the results of multivariate analysis, the presence of significant MR increased the risk of AF by 3,5 times, AR increased by 3,1 times. With CHF worsening to III-IV NYHA classes, the risk of AF increased by 2,1 times, with the presence of RCA — by 80%, obesity of 2 or 3 degrees — by 40%. An increase in the RV size indices for each mm/m2 increased the risk of AF by 14%; in the LV myocardium mass for each g/m2 — by 0,5%.Conclusion. Angiographic predictor of AF in patients with CAD is the RCA lesion