2013


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2013/№1

Description of chronic heart failure against the background of permanent atrial fibrillation

Koziolova N. A., Nikonova Yu. N., Shilova Ya. E., Agafonov A. V., Polianskaya E. A.

Keywords: atrial fibrillation, CHF


DOI: 10.18087/rhfj.2013.1.1806

Relevance. Data about CHF RF against the most commonly occurring permanent atrial fibrillation (AF), its pathogenetic mechanisms, structural and functional status of heart and target organs, course peculiarities has been insufficient, and even contradictory according to some studies. Objective. Detect peculiarities of CHF course in patients with permanent AF. Materials and methods. According to criteria of inclusion and exclusion, 120 patients with CHD and CHF FC II–III were examined. They were divided into 2 equal groups: 1st – patients with sinus rhythm, 2nd – with permanent AF. Factors of cardiovascular risk, angina and CHF severity with assessment of natriuretic peptides, structural and functional remodeling of the left heart, renal function and intercellular matrix collagenolysis were compared in both groups. Results. CHF against permanent AF in patients with CHD was characterized by more severe course, including stable angina (p=0.002), according to SHOKS (p=0.039), average daily HR (p<0.001) and atrial natriuretic factor А levels (p=0.036) and was associated with more frequent comorbide pathology (DM type 2, p=0.038; stroke, p=0.043) and RF. At assessment of structural and functional status of the left heart, LV myocardial hypertrophy (p=0.003) prevailed, with marked diastolic dysfunction (p=0.015) and left atrium dilatation (p<0.001), without significant differences between groups in EF and LV dimensions, myocardial collagenolysis marker – tissue inhibitor of matrix metalloproteinases type 1. With CHF and permanent AF, renal dysfunction was registered more often according to creatinine (p=0.037) and cystatine С (p<0.001) clearance. Conclusion. Development of CHF against permanent AF was characterized by certain RF, clinical pathogenetic laws of its development and involvement of target organs, which requires a special approach to selection of treatment strategies.
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Koziolova N. A., Nikonova Yu. N., Shilova Ya. E. et al. Description of chronic heart failure against the background of permanent atrial fibrillation. Russian Heart Failure Journal. 2013;14 (1):14-21

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