medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-14-26-32medalphabet-3812Research ArticleСтатьиХроническая систолическая сердечная недостаточность: связь ремоделирования правых отделов сердца и почечной дисфункции с нарушениями сердечного ритмаChronic systolic heart failure: association of remodeling of the right heart and renal dysfunction with cardiac arrhythmiashttps://orcid.org/0009-0004-5294-1352МолчановаЖ. В.MolchanovaZh. V.

Молчанова Жанна Владимировна - клинический ординатор по направлению «Кардиология».

Москва

Molchanova Zhanna V. - clinical resident in the direction of “Cardiology”.

Moscow

https://orcid.org/0000-0002-9738-1801ИванниковА. А.IvannikovA. A.

Иванников Александр Александрович - преподаватель Учебного центра, младший научный сотрудник отделения лучевой диагностики.

Москва

Ivannikov Alexander A. - teacher at the Training Center, junior researcher at Dept of Radiation Diagnostics.

Moscow

https://orcid.org/0009-0000-4513-7500МусаеваФ. М.MusaevaF. M.

Мусаева Фатима Мусаевна - клинический ординатор по направлению «Кардиология».

Москва

Musaeva Fatima M. - clinical resident in the direction of «Cardiology».

Moscow

ИвановД. И.IvanovD. I.

Иванов Дмитрий Игоревич, клинический ординатор по направлению «Кардиология».

Москва

Ivanov Dmitry I. - clinical resident in the direction of «Cardiology».

Moscow

https://orcid.org/0000-0002-6655-1273КосолаповД. А.KosolapovD. A.

Косолапов Денис Александрович - к. м. н., заведующий научным отделением для больных с сердечно-сосудистой патологией.

Москва

Kosolapov Denis A. - PhD Med, head of the Scientific Dept for Patients with Cardiovascular Pathology.

Moscow

https://orcid.org/0000-0002-6229-8629АлиджановаХ. Г.AlidzhanovaH. G.

Алиджанова Хафиза Гафуровна - д. м. н., старший преподаватель Учебного центра, старший научный сотрудник отделения неотложной кардиологии с методами неинвазивной диагностики.

Москва

Alijanova Hafiza G. - DM Sci (habil.), senior lecturer at the Training Center, senior researcher at Dept of Emergency Cardiology with Non-invasive Diagnostic Methods.

Moscow

doctorhafiza@mail.ruГБУЗ «Научно-исследовательский институт скорой помощи имени Н.В. Склифосовского Департамента здравоохранения Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202412082024014Кардиология. Неотложная медицина (2)2632Copyright © Молчанова Ж.В., Иванников А.А., Мусаева Ф.М., Иванов Д.И., Косолапов Д.А., Алиджанова Х.Г., 20242024Молчанова Ж.В., Иванников А.А., Мусаева Ф.М., Иванов Д.И., Косолапов Д.А., Алиджанова Х.Г.Molchanova Z.V., Ivannikov A.A., Musaeva F.M., Ivanov D.I., Kosolapov D.A., Alidzhanova H.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3812Введение

Введение. Ишемическая (ИКМП) и дилатационная (ДКМП) кардиомиопатии – ведущие причины хронической сердечной недостаточности (ХСН) с наиболее частым показанием к трансплантации сердца. Схожесть этих заболеваний состоит в широкой распространенности и высокой частоте смертности вследствие патологического ремоделирования как левых, так и правых камер сердца, что сопровождается прогрессированием ХСН, увеличивая риск внезапной сердечной смерти.

Цель исследования

Цель исследования. Изучение связи систолической функции левого желудочка (ЛЖ) с ремоделированием правых отделов сердца, дисфункцией почек и их связи с нарушением сердечного ритма.

Материалы и методы

Материалы и методы. В исследование включено 72 пациента с ХСН с низкой фракцией выброса (ХСНнФВ), которые находились на лечении в НИИ СП им. Н. В. Склифосовского в связи с ухудшающейся ХСН. I группу составили 48 пациентов с ДКМП, II группу – 24 пациента с ИКМП.

Результаты

Результаты. Фракция выброса (ФВ) ЛЖ у пациентов обеих групп была ≤30 %, однако значимо ниже регистрировалась в I группе (р=0,001). ФВ правого желудочка (ПЖ) в I группе была низкой и составила 24,6 [19,5; 28,5]%. В I группе объем правого предсердия (ПП) и размер ПЖ коррелировал с ФВ ЛЖ (r= –0,489, p=0,015 и r= –0,410, p=0,005 соответственно); каждое последующее увеличение объема ПП на 1 мл повышало вероятность возникновения фибрилляции предсердий (ФП) в 1,018 раза (ОШ: 1,018, 95 % ДИ: 1,0042–1,033, p=0,011). Расчетная скорость клубочковой фильтрации (рСКФ) ≤60 мл/мин/1,73 м2 повышала шансы развития желудочковой тахикардии (ЖТ) в 9,5 раза (ОШ: 9,5, 95 % ДИ: 2,32–38,87, p=0,002). Каждое последующее снижение рСКФ на 1 мл/мин/1,73 м2 увеличивало шансы развития ЖТ в 1,03 раза (ОШ: 0,967, 95 % ДИ: 0,937–0,988, p=0,036).

Выводы

Выводы. У пациентов с ХСНнФВ, независимо от этиологии, снижение ФВ ЛЖ приводит к структурно-функциональным изменениям правых отделов сердца. У лиц с ДКМП увеличение объема ПП на 1 мл повышает вероятность возникновения ФП в 1,018 раза; снижение рСКФ на 1 мл/мин/1,73 м2 увеличивает шансы развития ЖТ в 1,03 раза.

Introduction

Introduction. Ischemic (ICMP) and dilated cardiomyopathy (DCMP) are the leading causes of chronic heart failure (CHF) with the most frequent indication for heart transplantation. The similarity of these diseases consists in the widespread and high mortality rate due to pathological remodeling of both the left and right chambers of the heart, which is accompanied by the progression of CHF, increasing the risk of sudden cardiac death.

The purpose of the study

The purpose of the study. To study the relationship of systolic function of the left ventricle (LV) with remodeling of the right heart, renal dysfunction and their relationship with cardiac arrhythmia.

Materials and methods

Materials and methods. The study included 72 patients with CHF with reduced ejection fraction (CHFrEF), who were being treated at the N. V. Sklifosovsky Scientific Research Institute of EM in connection with worsening CHF. Group I consisted of 48 patients with DCMP; group II – 24 patients with ICMP.

Results

Results. LV ejection fraction (LV EF) in patients of both groups was <30 %, but it was significantly lower in group I (p=0.001). The EF of the right ventricle (RV) in group I was low and amounted to 24.6 [19.5; 28.5]%. In group I, the volume of the right atrium (PP) and the size of the pancreas correlated with LV EF (r= –0.489, p=0.015 and r= –0.410, p=0.005, respectively); each subsequent increase in the volume of right atrium (RA) by 1 ml increased the likelihood of atrial fibrillation (AF) by 1.018 times (OR: 1.018, 95 % CI: 1.0042–1.033, p=0.011). The estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 increased the chances of ventricular tachycardia (VT) by 9.5 times (OR: 9.5, 95 % CI: 2.32–38.87, p=0.002). Each subsequent decrease in eGFR by 1 ml/min/1.73 m2 increased the chances of developing VT by 1.03 times (OR: 0.967, 95 % CI: 0.937–0.988, p=0.036)].

Conclusions

Conclusions. In patients with CHFrEF, regardless of the etiology, a decrease in LV EF leads to structural and functional changes in the right parts of the heart. In individuals with DCMP, an increase in RA volume by 1 ml increases the likelihood of AF by 1.018 times; a decrease in eGFR by 1 ml/min/1.73 m2 increases the chances of developing VT by 1.03 times.

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The authors declare that there are no conflicts of interest present.