Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction.

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologiya Pub Date : 2024-03-31 DOI:10.18087/cardio.2024.3.n2466

I P Zakharov, P Sh Chomakhidze, F Yu Kopylov, E A Sultygova, D F Mesitskaya, E A Lyubimova, D A Andreev

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Abstract

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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确定射血分数完整和降低的慢性心力衰竭患者心房颤动阵发性发作的风险。

目的：通过超声心动图（EchoCG）确定射血分数保留和降低的慢性心力衰竭（CHF）患者发生心房颤动（AF）的预测因素：分析了 168 例无房颤病史的 I-III 期 CHF 患者的数据。所有患者均按照扩展方案接受了超声心动图检查，以确定舒张功能障碍（DD）、左心房射血分数（LA EF）和左心房整体应变（LA GS）。组织多普勒成像（TDI）用于评估左心室早期（E）和晚期（A）充盈速度以及二尖瓣瓣环舒张早期（E'）和晚期（A'）速度。对所有患者进行了为期 3 天的心律 Holter ECG 监测（HM ECG），并利用远程医疗技术进行了为期 7 天的 ECG 监测，每天 3 次，每次 3 分钟。随访期为 3 个月或直至房颤发作：研究期间，使用各种心律监测方法检测到 41 名（24.4%）患者出现阵发性房颤（pAF）。有 10 名（24.4%）患者在阵发性房颤期间出现心悸症状，心悸症状是通过 CardioQVARK® 设备、HM 心电图或 12 导联心电图记录的。5名患者（12.2%）在日常心电图监测中发现心房颤动，但无相关主诉。在 24、48 和 72 小时内，HM ECG 分别检测到 8、2 和 4 个病例（19.5%、4.8% 和 9.7%）；单通道 CardioQVARK® 在连续 7 天每天使用 3 次的情况下，检测到 30 个病例（73.2%）。这些结果表明，心房颤动经常发生在无伴随症状的慢性心力衰竭患者身上。使用 CardioQVARK® 检测心房颤动的方法显示出良好的效果：它比 HM 心电图有效两倍，比 12 导联心电图有效三倍。此外，根据超声数据，房颤患者的以下参数发生了显著变化：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 <5.7cm/s（OR 0.97，95% CI：0.94-1.00），p=0.026。2 级 DD 的结果没有统计学意义（OR 1.1，95% CI：0.7-1.5，P=0.54）。然而，在心房颤动患者中，DD的检出率更高，占34%，而在非心房颤动患者中，DD的检出率仅为29%：结论：慢性心力衰竭患者罹患心房颤动的风险很高（24.4%）。75%的房颤患者感觉不到阵发性心房颤动的发生。所有慢性阻塞性肺病患者都应接受 EchoCG 检查，同时评估 LA EF、TDI E med 和 LA GS，以确定心房颤动的高危人群。使用 CardioQVARK® 设备进行心律远程监测是一种可靠的方法，可用于早期发现心房颤动，并及时为慢性阻塞性肺病患者启动抗凝治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.