Assessment of progression of atrial fibrillation in middle-aged individuals with hypertension in combination with comorbid extracardial diseases

Abstract

Purpose. To assess the progression of atrial fibrillation in middle-aged people with hypertension in combination with comorbid extracardiac diseases.Materials and methods. In an observational cohort study, 308 patients aged 45–65 years with atrial fibrillation (paroxysmal and persistent forms) with hypertension in combination with extracardiac pathology were observed: diabetes mellitus (n = 40), thyrotoxicosis (n = 42), hypothyroidism (n = 59), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47). The control group consisted of 56 patients with hypertension + AF without concomitant extracardiac disease. The level of MMP-9 was determined using the Human MMP-9 (total) Immunoassay test-system (USA); NT-proBNP —  using the NTproBNP-IFA-Best reagent kit; galectin-3 —  with ELISA —  Bender MedSystems (Austria). Echocardiography was performed using an Acuson Aspen apparatus (USA), 24-hour ECG monitoring with Schiller Medilog Holter system. All statistical calculations were carried out in the program Rstudio 0.99.879 (RStudio, USA).Results. In patients with hypertension and atrial fibrillation, the combination of diabetes mellitus (p = 0.041) and abdominal obesity (p = 0.004) is the most prognostic factor for AF progression. In groups of patients with diabetes mellitus, hypothyroidism and abdominal obesity, the most pronounced indicators of diastolic dysfunction of the left ventricle were: E/A, LVMI (men); the size of the left atrium and the end-diastolic size of the left ventricle are increased in all clinical groups. The prognostic value of biomarkers of fibrosis and remodeling of galectin-3 and MMP-9, and NT-proBNP in the progression of atrial fibrillation in patients with hypertension in combination with extracardial diseases is shown.Conclusion. There is no doubt that in case of hypertension, the decompensation of long-term hypertrophic myocardium is based on a violation of the balanced growth of its various structures and the formation of fibrosis and myocardial dystrophy, which was confirmed in the present study. The detected elevated levels of MMP-9, galectin-3 and NT-proBNP, as well as ultrasonic signs of myocardial remodeling, confirmed that they statistically significantly affect the progression of atrial fibrillation. In this regard, a personalized approach to a patient with atrial fibrillation in combination with comorbid pathology is required, especially in middle-aged people at the stage of comorbidity formation, under the conditions of received diagnostic information on the electrical function of the heart and assessment of the functional capabilities of CVS during its transition to various levels of functioning.