COMORBID PATHOLOGY IN PATIENTS WITH ATRIAL FIBRILLATION AND PULMONARY EMBOLISM

Aims. Based on the data of the Register of new cases of pulmonary arterial thromboembolism (PE) in Tomsk hospitals (2003–2012), to study the development of thromboembolism in patients with atrial fibrillation (AF).

Results. The database of the Register of new cases of hospital PE included data from patients with PE (751 people) who died in the city’s hospitals and underwent autopsy. Among them, 238 patients were identified who had AF before the development of PE (in 185 patients — a permanent form of AF, in 53 — paroxysmal and persistent). Among metabolic disorders, 25% of patients showed obesity of various degrees and 27% had type 2 diabetes. Chronic heart failure 2 stages in the phase of decompensation was diagnosed in 41% of patients. The number of verified cases of PE in persons with AF did not differ significantly from patients without fibrillation and was 40%. According to autopsy data, pulmonary embolism is recognized as the main cause of death in more than half of people with AF (in 131 cases). A massive volume of pulmonary artery disease was detected in 109 patients with AF (46%). Among patients with thromboembolism from the right heart chambers, AF as a whole (regardless of form) was found in 56% of cases, that is, significantly more often than in patients with a source of embolism in the inferior vena cava (14.3%, p=0.005), veins of the lower limbs (27%, p<0.001) and veins of the pelvis (2.6%, p=0.014). Similar relationships were found in persons with chronic AF. For the paroxysmal form of differences between groups with different sources of embolism, it was not possible to identify. According to autopsy data, in patients with atrial fibrillation, the right heart was the source of PE in 121 patients (48%), 85% of them in the right atrial appendage.

1. Клинические рекомендации по диагностике и лечению фибрилляции предсердий. Российское кардиологическое общество, Всероссийское научное общество специалистов по клинической электрофизиологии, аритмологии и кардиостимуляции. Ассоциация сердечно-сосудистых хирургов. М., 2012: 110 [Clinical recommendations for the diagnosis and treatment of atrial fibrillation. Russian Cardiology Society, All-Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Pacemakers. Association of Cardiovascular Surgeons. Мoscow, 2012: 110] (In Russ).

2. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B., Castella M., Diener H. C., Heidbuchel H., Hendriks J., Hindricks G., Manolis A. S., Oldgren J., Popescu B. A., Schotten U., Van Putte B., Vardas P., Agewall S., Camm J., Baron Esquivias G., Budts W., Carerj S., Casselman F., Coca A., De Caterina R., Deftereos S., Dobrev D., Ferro J. M., Filippatos G., Fitzsimons D., Gorenek B., Guenoun M., Hohnloser S. H., Kolh P., Lip G. Y., Manolis A., McMurray J., Ponikowski P., Rosenhek R., Ruschitzka F., Savelieva I., Sharma S., Suwalski P., Tamargo J. L., Taylor C. J., Van Gelder I. C., Voors A. A., Windecker S., Zamorano J. L., Zeppenfeld K. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 2016; 37(38): 2893–2962. DOI: 10.1093/eurheartj/ehw210.

3. Bikdeli B., Abou Ziki M. D, Lip G. Y. H. Pulmonary Embolism and Atrial Fibrillation: Two Sides of the Same Coin? A Systematic Review. Semin. Thromb. Hemost. 2017 Nov; 43(8): 849–863. DOI: 10.1055/s-0036-1598005.

4. Gex G., Gerstel E., Righini M., Gal L. E. G., Aujesky D., Roy P. M., Sanchez O., Verschuren F., Rutschmann O. T., Perneger T., Perrier A. Is atrial fibrillation associated with pulmonary embolism? J. Thromb. Haemost. 2012; 10(3): 347–351. DOI: 10.1111/ j.1538-7836.2011.04608.

5. Flegel K. M. When atrial fibrillation occurs with pulmonary embolism, is it the chicken or the egg? CMAJ. 1999; 160(8): 1181– 1182.

6. Hald E. M., Enga K. F., Løchen M. L., Mathiesen E. B., Njølstad I., Wilsgaard T., Braekkan S. K., Hansen J. B.Venous thromboembolism increases the risk of atrial fibrillation: The Tromso study. J. Am. Heart Assoc. 2014; 3: e000483. DOI: 10.1161/ JAHA.113.000483.

7. Adikari D., Yuan D., Lau J., Chow V., Chung T., Yong A., Kritharides L., Ng A. The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism. PLoS One. 2016; 11(3): e0150448. DOI: 10.1371/journal.pone.0150448.

8. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm A. J., Kirchhof P., Lip G. Y., Schotten U., Savelieva I., Ernst S., Van Gelder I. C., Al-Attar N., Hindricks G., Prendergast B., Heidbuchel H., Alfieri O., Angelini A., Atar D., Colonna P., De Caterina R., De Sutter J., Goette A., Gorenek B., Heldal M., Hohloser S. H., Kolh P., Le Heuzey J. Y., Ponikowski P., Rutten F. H. Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010 Oct; 12(10): 1360–1420. DOI: 10.1093/europace/euq350.

9. Nordström M., Lindblad B. Autopsy-verified venous thromboembolism within a defined urban population–the city of Malmö, Sweden. APMIS. 1998 Mar; 106(3): 378–384.

10. Ögren M., Bergqvist D., Eriksson H., Lindblad B., Sternby N. H. Prevalence and risk of pulmonary embolism in patients with intracardiac thrombosis: a population-based study of 23796 consecutive autopsies. Eur. Heart J. 2005; 26: 1108–1114. DOI: 10.1093/eurheartj/ehi130.

11. Kukla P., McIntyre W. F., Koracevic G., Kutlesic-Kurtovic D., Fijorek K., Atanaskovic V., Krupa E., Mirek-Bryniarska E., Jastrzę- bski M., Bryniarski L., Pruszczyk P., Baranchuk A. Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism. Am. J. Cardiol. 2015; 115(6): 825–830. DOI: 10.1016/j.amjcard.2014.12.049.

12. Barra S. N. C., Paiva L. V., Providência R., Fernandes A., Marques A. L. Atrial Fibrillation in Acute Pulmonary Embolism. Emerg. Med. J. 2014; 31(4): 308–312.

13. Икоркин М. Р., Жаринов О. И., Левчук Н. П., Бобров В. А. Предикторы сохранения синусового ритма через 6 месяцев после кардиоверсии у пациентов с персистирующей фибрилляцией предсердий. Український кардіологічний жур- нал. 2010; 1: 50–59 [Ikorkin M. R., Zharinov O. I., Levchuk N. P., Bobrov V. A. Predictors of sinus rhythm conservation 6 months after cardioversion in patients with persistent atrial fibrillation. Ukr. Cardiol. J. 2010; 1: 50–59] (In Ukr).

14. Васильцева О. Я., Ворожцова И. Н., Лавров А. Г., Карпов Р. С. Оценка факторов неблагоприятного прогноза у пациентов с тромбоэмболией легочной артерии. Терапевтический архив. 2016; 12: 28–33 [Vasilceva O. Ya., Vorozhcova I. N., Lavrov A. G., Karpov R. S. Evaluation of the factors of unfavorable prognosis in patients with pulmonary embolism. Ther. archive. 2016; 12: 28–33] (In Russ). DOI: 10.17116/terarkh2016881228-32.

15. Васильцева О. Я., Ворожцова И. Н., Крестинин А. В., Стефанова Е. В., Карпов Р. С. Влияние основной нозологической патологии и выбранной врачебной стратегии на исход тромбоэмболии легочной артерии. Кардиология. 2017; 1: 37–41 [Vasilceva O. Ya., Vorozhcova I. N., Krestinin A. V., Stefanova E. V., Karpov R. S. Influence of the main nosological pathology and the chosen medical strategy on the outcome of pulmonary embolism. Cardiology. 2017; 1: 37–41] (In Russ). DOI: org/10.18565/cardio.2017.1.37-41.

16. Barrios D., Morillo R., Lobo J. L., Nieto R., Jaureguizar A., Portillo A. K., Barbero E., Fernandez-Golfin C., Yusen R. D., Jiménez D. Assessment of right ventricular function in acute pulmonary embolism. Am. Heart J. 2017 Mar; 185: 123–129. DOI: 10.1016/j. ahj.2016.12.009.

17. Самородская И. В. Индекс массы тела и парадокс ожирения. Русский медицинский журнал. 2014; 2: 170–176 [Samorodskaya I. V. Body mass index and the paradox of obesity. Native Russian. Rus. Med. J. 2014; 2: 170–176] (In Russ).

18. Дедов И. И., Шестакова М. В., Максимова М. А. Федеральная целевая программа «Сахарный диабет»: методические рекомендации. М., 2002: 87 [Dedov I. I., Shestakova M. V., Maksimova M. A. Federal Targeted Program «Diabetes Mellitus»: guidelines. Moscow: 2002: 87] (In Russ).

19. Сахарный диабет: диагностика, лечение, профилактика. Под ред. И. И. Дедова, М. В. Шестаковой. М.: МИА, 2011: 800 [Diabetes mellitus: diagnosis, treatment, prevention. Ed. I. I. Dedov, M. V. Shestakova. Moscow: МIА, 2011: 800] (In Russ).

20. Икоркин М. Р., Жаринов О. И., Левчук Н. П., Дынник О. Б., Бо- бров В. А. Диагностические возможности чреспищеводной эхокардиографии у больных с фибрилляцией предсердий. Український кардіологічний журнал. 2008; 3: 102–110 [Ikorkin M. R., Zharinov O. I., Levchuk N. P., Dynnik O. B., Bobrov V. A. Diagnostic possibilities of transesophageal echocardiography in patients with atrial fibrillation. Ukr. Card. J. 2008; 3: 102–110] (In Ukr).

21. Уэстбрук К., Каут Рот К., Тэлбот Дж. Магнитно-резонансная томография. Практическое руководство / пер. с англ., 2-е изд. М.: БИНОМ. Лаборатория знаний, 2013: 448 [Westbrook C., Kaut Roth K., Talbot J.; Magnetic resonance imaging. Practical guidance / transl. from English. 2nd ed. Moscow: BINOM. Laboratory of Knowledge, 2013: 448] (In Russ).