SPECIFICS OF MYOCARDIAL REMODELING IN PATIENTS WITH ATRIAL FIBRILLATION AND ASSOCIATED ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i1.12822Keywords:
remodeling, atrial fibrillation, arterial hypertension, diabetesAbstract
SUMMARY. In modern publications the term "Hypertensive heart disease" is traced. It is regarded as a set of changes in the LV, LA and coronary arteries due to chronic hypertension. The development of AF in LVH is realized through certain triggers that are possible in the formation of HHD. The formation of re-entry sites around fibrosis zones in the hypertrophied part of the myocardium contributes to the occurrence of AF in patients with HHD. Therefore, AF should be considered as one of the manifestations of HHD.
The aim – to determine the effect of myocardial remodeling type on the occurrence and persistence of AF in hypertension and type 2 DM in the context of HHD.
Material and Methods. 214 patients with AF, hypertension and DM were examined. Men – 56.5 %, woman – 43.5 %. Among patients with AF, 34.3 % showed paroxysmal, 46.4 % persistent and 19.3 % permanent.
Results. HHD was detected in 67.2 % of patients with hypertension. At HHD the anamnesis of hypertension made (14,37±0,76) years, whereas at persons without it – (7,92±0,47) years (p=0,01). Age (p=0.002) and concentric LV remodeling (p=0.004) were the most significant predictors of the first episode of AF. The relationship between the increase in RWT in our patients with an increase in the duration of hypertension and SBP (p=0.0001).
The formation of a concentric type of LVH with concomitant hypertension and DM was associated with the development of AF. The main risk factors for AF in patients with hypertension were LV hypertrophy, LA dilatation, concentric form of LV remodeling and obesity. The development of eccentric hypertrophy was influenced only by AF, and most often its constant form. (p = 0.05) It is proved that concentric hypertrophy is more common in women and in DM, while in obesity - eccentric.
Conclusion. Thus, HHD develops with a duration of hypertension of about 14 years. The development of the first episode of AF was influenced by age and concentric hypertrophy. RWT increased with longer duration of hypertension and increasing the level of SBP. The development of eccentric hypertrophy was facilitated by AF, and most often its constant form. Concentric hypertrophy develops in DM, in obesity - eccentric.
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