Personalized algorithm for formation of risk groups for progression and development of complications of atrial fibrillation in hypertension in combination with extracardial diseases

Aim. To develop a personalized algorithm for predicting the progression of atrial fibrillation and its complications in hypertension in combination with extracardial diseases. Methods. The observational cohort study observed 308 men aged 45–60 years with AF and AH in combination with extracardial pathology: diabetes mellitus (DM; n = 40), diffuse toxic goiter (TTZ; n = 42); hypothyroidism (GT; n = 59), abdominal obesity (AO; n = 64) and chronic obstructive pulmonary disease (COPD; n = 47). The comparison group consisted of 56 patients without extracardial pathology. Clinical, laboratory, anthropometric data, results of daily ECG monitoring and echocardiography were evaluated. All statistical calculations were performed in Rstudio program. Results. Found significant predictors of progression of atrial fibrillation: indicators of remodeling: galectin-3, which increase by 1 ng/l increases the risk of progression to 1.0030 (1.0006; 1.0050) times (p = 0.016); PL (p < 0.001), with an increase of 1 cm, the risk increases to 2.67 (1.58; 4.65) times; KDR (p = 0.025), with the increase of 1 cm decrease the chance of atrial fibrillation recurrence in 0.13 (0.02; 0.65) and LVMWI, where the increase LVMWI 1 g/m 2 increases the risk of progression of AF at 0.9 times; also, the inflammation index-with an increase in IL-6 by 1 PG/l, the risk increases by 0.6 times, and the vascular stiffness marker MMP-9 – an increase by 1 ng/ml increases the risk of progression by 0.16 times. It was determined that emergency hospitalization for the progression of CHF during the year in patients with atrial fibrillation was significantly more common in all clinical groups, except for patients with hypothyroidism. Statistically significant predictors of hospitalization for CHF progression were revealed: increase of LP size by 1 cm increases CHF risk by 5.04 (1.80; 16.10) times; an increase in NT-proBNP by 1 pg/l increases the risk of CHF by 1.01 (1.00; 1.02) times. The comparative assessment of the incidence of cardioembolism in these groups, although not showed a statistically significant difference, but in percentage terms was higher in patients with atrial fibrillation – 11.2 vs. 6.0 % in patients without atrial fibrillation, the relative risk of confidence interval – 3.736 (0.500; 26.900). Conclusion. The developed personalized algorithm can be used to assess the prognosis of progression of atrial fibrillation and the development of its complications in hypertension in combination with extracardial diseases

atrial fibrillation, comorbid diseases, personified assessment

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