Серцево-судинний ризик у пацієнтів з неклапанною персистуючою фібриляцією передсердь

O. S. Kalashnykova

doi:10.26641/2307-0404.2013.2.15946

Автор(и)

O. S. Kalashnykova ДЗ «Дніпропетровська медична академія МОЗ України», Україна

DOI:

https://doi.org/10.26641/2307-0404.2013.2.15946

Ключові слова:

фібриляція передсердь, серцево-судинні фактори ризику, тромбоемболічні ускладнення

Анотація

Results of cardiovascular risk factors assessment of 133 patients with persisting non-valvular atrial fibrillation (AF) (main group) being admitted for electrical cardioversion performance and comparison of these risk factors with cardiovascular risk profile of 6535 AF patients from Cohort 1 of the international GARFIELD registry (group of comparison) are revealed in the article. Patients in the main group were older than 65 years (33,8%), in European population of GARFIELD registry the majority of patients older than 65 years – 73,8%; p<0,001. There were more women in European population of GARFIELD registry in comparison with our patients (44,8% vs 28,6%;р<0,001). With regard to co-morbidity characteristics, patients in our study had higher BMI (31,9 ± 5,7 vs 28,5 ± 5,2; p<0,001), hypercholesterolaemia (72,9% vs 46,1%; p<0,001), moderate renal dysfunction (GFR 30-59 mL/min) (36,8% vs 12,1%; p<0,001) and alcohol abuse (6,8% vs 1,1%). Number of patients with the risk of thromboembolism complications (TEC) ≥ 2 score by CHA2DS2-VASc was higher in European population of GARFIELD registry (86,0% vs 68,4%, <0,001), that is explained by prevalence of elderly patients in this group. The use of oral anticoagulants for thromboembolism prevention in high risk patients was low in both groups (approximately 70,0%), a large majority of patients in both groups were not treated effectively (64,1% vs. 55%, p = 0,148). Prevalence of TEC in case-history was similar in both groups (11,4% vs 15,9%, p = 0,141). So in our study patients with persistent non-valvular AF are characterized by higher cardiovascular risk in younger age in comparison with European population of AF patients from GARFIELD registry. For identification of “truly low-risk” patients with TEC, further improvement of risk stratification is required.

Біографія автора

O. S. Kalashnykova, ДЗ «Дніпропетровська медична академія МОЗ України»

Кафедра госпітальної терапії № 2
(зав. – академік НАМН України, д. мед. наук, професор Г.В. Дзяк)

Посилання

Дзяк Г.В. Мерцательная аритмия: современное состояние проблемы / Г.В. Дзяк, С.Л. Локшин // Междунар. мед. журнал. – 1997. - №3. – С. 6-9.

Панченко Е.П. Профилактика кардиоэмбо¬ли-ческого инсульта у больных мерцательной аритмией / Е.П. Панченко // Кардиоваскуляр. терапия и профи-лактика. – 2003. – Т. 2, № 3. – С. 64-69.

Шевелев В.И. Чреспищеводное исследование грудного отдела аорты у пациентов пожилого возраста с неклапанной фибрилляцией предсердий / В.И. Шевелев, С.Г. Канорский, А.В. Поморцев // Ультра-зву¬ковая и функциональная диагностика. – 2010. - №1. – С. 61-64.

Atrial fibrillation, Stroke, and acute Antithrom-botic Therapy. Analysis of 2012 participants in the SPAF I-III clinical trials / R.G. Hart, L.A. Pearce, R. McBride [et al.] // Stroke. – 1999. – Vol. 30. – P. 1223-1229.

Cardioembolic vs. Noncardioembolic strokes in atrial fibrillation: frequency and effect of antithrombotic agents in the Stroke Prevention in Atrial Fibrillation studies / R.G. Hart, L.A. Pearce, V.T. Miller [et al.] // Car-diovasc. Dis. – 2000. – Vol. 10. – P. 39-43.

Carotid stenosis in patients with atrial fibrillation. Prevalence, risk factors and relationship to stroke in the Stroke Prevention in Atrial Fibrillation Study / M.C. Kan-ter, C.H. Tegeler, L.A. Pearce [et.al.] // Arch. Intern. Med. – 1994. – Vol. 154. – P. 1372-1377.

Goto S. Cardiovascular risk factors in patients at high risk of atherothrombosis: what can be learned from registries? / S. Goto // Thromb. Haemost. – 2008. – Vol. 100. – P. 611-613.

Hart R. Atrial fibrillation and Stroke. Concepts and controversies / R. Hart, J.L. Halperin // Stroke. – 2001. – Vol. 32. – P. 803-808.

Hart R.G. Atrial fibrillation and stroke prevention / R.G. Hart // N. Engl. J. Med. – 2003. – Vol. 349. – P. 1015-1016.

Lip G.Y. Atrial fibrillation and stroke prevention / G.Y. Lip, H.S. Lim // Lancet Neurol. – 2007. – Vol. 6. – P. 981-993.

Primary prevention of Ischaemic Stroke. A sta-tement for Healthcare Professionals from the stroke coun¬cil of the American Heart Assotiation / L.B. Goldstein, C.R. Adams, K. Becker [et. al.] // Circulation. – 2001. – Vol. 103. – P. 163-182.

Risk factors for ischaemic and intracerebral haemor¬rhagic stroke in 22 countries (the INTERSTROKE study): a case-control study / M.J. O’Donnell, D. Xavier, L. Liu [et. al] // Lancet. – 2010. – Vol. 376. – P. 112-123.

Stroke Prevention in Atrial Fibrillation Investi-gators: Transesophageal echocardiographic correlates of throm¬boembolism in high-risk patients with non-valvular atrial fibrillation: The Stroke Prevention in Atrial Fibril-lation Investigators Committee on Echocardiography // Ann. Inter. Med. – 1998. – Vol. 128. – P. 639-647.

Wolf P.A. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study / P.A. Wolf, R.D. Abbott, W.B. Kannel // Stroke. – 1991. – Vol. 22. – P. 983-988.

Dzyak GV, Lokshin SL. Mertsatelnaya aritmiya: sovremennoe sostoyanie problemyi. Mezhdunar med zhurnal. 1997;3:6-9.

Panchenko EP. Profilaktika kardioembo¬liches-kogo insulta u bolnyih mertsatelnoy aritmiey. Kardiovas-kulyar terapiya i profilaktika. 2003;2(3):64-69.

Shevelev VI, Kanorskiy SG, Pomortsev AV. Chrespischevodnoe issledovanie grudnogo otdela aortyi u patsientov pozhilogo vozrasta s neklapannoy fibrillyatsiey predserdiy. Ultrazvukovaya i funktsionalnaya diagnostika. 2010;1:61-64.

Hart RG, Pearce LA, McBride R. Atrial fibril-lation, Stroke, and acute Antithrombotic Therapy Analysis of 2012 participants in the SPAF I-III clinical trials. Stroke. 1999;30:1223-9.

Hart RG, Pearce LA, Miller VT. Cardioembolic vs Noncardioembolic strokes in atrial fibrillation: fre¬quency and effect of antithrombotic agents in the Stroke Prevention in Atrial Fibrillation studies. Cardiovasc Dis. 2000;10:39-43.

Kanter MC, Tegeler CH, Pearce LA. Carotid ste-nosis in patients with atrial fibrillation. Prevalence, risk factors and relationship to stroke in the Stroke Prevention in Atrial Fibrillation Study. Arch Intern Med. 1994;154:1372-7.

Goto S. Cardiovascular risk factors in patients at high risk of atherothrombosis: what can be learned from registries? Thromb Haemost. 2008;100:611-3.

Hart R, Halperin JL. Atrial fibrillation and Stroke. Concepts and controversies. Stroke.2001;32:803-8.

Hart RG. Atrial fibrillation and stroke prevention. N Engl J Med.2003;349:1015-6.

Lip GY, Lim HS. Atrial fibrillation and stroke pre-vention. Lancet Neurol. 2007;6:981-93.

Goldstein LB, Adams CR, Becker K. Primary prevention of Ischaemic Stroke. A statement for Health-care Professionals from the stroke council of the Ame-rican Heart Assotiation. Circulation. 2001;103:163-82.

O’Donnell MJ, Xavier D, Liu L. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control stu-dy. Lancet. 2010;376:112-23.

Stroke Prevention in Atrial Fibrillation Inves-tigators: Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with non-valvular atrial fibrillation: The Stroke Prevention in Atrial Fib-rillation Investigators Committee on Echocardiography. Ann Intern Med. 1998;128:639-47.

Wolf PA, Abbott RD, Kannel WB. Atrial fibril-lation as an independent risk factor for stroke: the Fra-mingham Study. Stroke. 1991;22:983-8.