АННОТАЦИЯ В проспективном когортном исследовании участвовали 173 мужчины 45-65 лет с артериальной гипертонией (АГ) и фибрилляцией предсердий (ФП). Больные были разделены на 3 группы: 1-я группа-53 пациента с абдоминальным ожирением (АО) и сахарным диабетом (СД) типа 2; 2-я группа-64 больных с АО без СД; 3-я группа, группа сравнения-56 больных АГ и ФП без сопутствующей патологии. Исследуемые группы различались по возрасту: средний возраст больных 1-й и 2-й группы был значимо выше, чем у больных группы сравнения. При сравнении биохимических показателей оказалось, что у больных 1-й и 2-й группы уровень калия, мочевины и креатинина крови был достоверно выше по отношению к больным группы сравнения. Маркер фиброза галектин-3 у больных 1-й группы был выше, чем у больных группы сравнения. У пациентов 1-й и 2-й групп отмечалось достоверное уменьшение индекса массы миокарда левого желудочка (ИММЛЖ) по отношению к группе сравнения. Снижение ИММЛЖ при сопутствующей коморбидной патологии может быть связано с метаболическими процессами, которые могут замедлять компенсаторную мышечную гипертрофию миокарда. Таким образом, больным с фибрилляцией предсердий на фоне артериальной гипертонии, абдоминального ожирения и сахарного диабета необходима ранняя диагностика и коррекция как АГ, так и экстракардиальных коморбидных заболеваний с целью профилактики раннего и быстро прогрессирующего поражения миокарда. Ключевые слова: фибрилляция предсердий, артериальная гипертония, нарушение ритма сердца, сахарный диабет, абдоминальное ожирение.

Aim. To study the clinical course of atrial fibrillation in patients with arterial hypertension and extracardiac comorbid pathology depending on the administered therapy.Methods. 207 men aged 45–65 years with atrial fibrillation (paroxysmal and persistent) and arterial hypertension in combination with diabetes mellitus (n = 40), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47) were recruited to a observational cohort study. 56 patients with atrial fibrillation and arterial hypertension but without any extracardiac diseases were included in the comparison group. Clinical and anthropometric parameters were assessed in all patients. Adherence to therapy was estimated with the Morisky-Green test. All patients underwent ECG; electrocardiographic holter monitoring, 24-hour blood pressure monitoring with the Daily Monitoring Systems SCHILLER (Schiller, Switzerland), 2D and M-mode echocardiography using a Vivid 7 device (General Electric, USA). The statistical analysis was performed in the Rstudio software (version 0.99.879, RStudio, Inc., MA, USA).Results. 66% of patients with atrial fibrillation and arterial hypertension had concomitant extracardiac comorbid pathology, of them 20% of had diabetes mellitus, 22% with chronic obstructive pulmonary disease, and 24% with abdominal obesity. The clinical groups were comparable in electro impulse and drug therapy. Patients who received medical treatment were frequently admitted to hospitals for atrial fibrillation recurrence (p<0.001), compared with those who underwent electro impulse therapy. Adherence to antiarrhythmic therapy was low in the entire cohort of patients. There were no significant differences found between the clinical groups.Conclusion. Early diagnosis of the factors contributing to the progression of AF, the prescription of additional therapy for the secondary prevention of arrhythmia and the choice of its optimal treatment strategy may slow the progression of arrhythmia and the development of CHF, which will improve not only the clinical status of patients, but also their prognosis.

Purpose. To study the peculiarities of the clinical course of atrial fibrillation in patients with arterial hypertension and obesity.Materials and methods. 127 patients were observed within the observational cohort studies. Of these, 64 patients with atrial fibrillation, arterial hypertension and obesity in the control group, while the experimental group consisted of 63 patients with atrial fibrillation, arterial hypertension and normal BMI (24.1±2.2) kg/m2. During our work we assessed clinical, anthropometric and laboratory indicators, as well as the results of instrumental examination: ElectroCG; Daily monitoring of ECG, EchoCG. Comparison of binary and categorical indicators was carried out upon an accurate bilateral F test. Statistical hypothesis testing was carried out at critical significance value p=0.05, i.e. the difference was considered statistically significant if p<0.05.Results. Body mass index (BMI) in patients with atrial fibrillation, hypertension and obesity amounted to 35.2±4.6 kg/m2. The average age in all clinical groups was 60.5±9.2 years old, and patients with obesity were significantly younger (p<0.05) - 53.3±6.1 years old than patients with normal BMI - who were 59.8±7.4 years old. Patients with hypertension, atrial fibrillation and obesity often had a persistent form of AF 71%. General assessment of the lipid profile indicated that only patients with obesity and hypothyroidism showed a significantly high level of triglycerides. (p<0.001). There was an increase in NT-proBNP (p=0.001) and galectin-3 (p=0.005). There was a consistent increase of the end-diastolic dimension of the left ventricle in the left atrium; thickening of the left ventricular posterior and the interventricular septum in compared groups proved equivocal, while the LVMMI (p<0.05) was significantly lower in patients with obesity than in the experimental group.Conclusion. The presence of obesity in patients with atrial fibrillation and arterial hypertension adversely affects certain biochemical and ultrasound parameters, however, many of the criteria characterizing cardiovascular risk and prognosis did not reveal significant differences, which requires further in-depth study of this problem and identification of a possible “obesity paradox” in the group of patients with atrial fibrillation, arterial hypertension and obesity.

Objective. To evaluate adherence to therapy in patients with hypertension (HTN) and atrial fibrillation (AF) in combination with extracardiac comorbid pathology. Design and methods. In an observational cohort study, 884 patients aged 45–65 years with AF (paroxysmal and persistent form) and HTN were observed, in combination with extracardiac comorbid diseases: diabetes mellitus (DM), n = 123; abdominal obesity (AO), n = 171; chronic obstructive pulmonary disease (COPD), n = 137, hypothyroidism, n = 156; thyrotoxicosis, n = 112. The comparison group consisted of 185 patients with AF and HTN, without concomitant extracardiac pathology. Clinical, anthropometric parameters, the Morischi–Green adherence test were evaluated in the work. To assess the social aspects of low adherence, special questionnaires were developed. All statistical calculations were performed using the Rstudio program. Results. Among patients with AF and HTN, 66 % had concomitant extracardiac comorbid pathology, 20 % of them with DM; COPD was detected in 22 % of patients, and AO was observed in 44 % of patients, 6 % patients had thyroid disease. 15,2 % patients were insufficiently adherent (ADH), 37,2 % were not adherent to therapy (NADH), and only 47,8 % respondents were adherent to therapy. The duration of HTN was not a significant motivation for adherence, because the NADH group had a significantly longer duration of arterial hypertension compared with the ADH group (12.3 vs 10.5 years; p < 0.03); patients with the permanent form of AF were more than ADH (p = 0,001), and the adherence did not differ between groups depending on extracardiac diseases. The blockers of the renin-angiotensin-aldosterone system showed the greatest use — up to 66 %, while adherent patients were more likely to take single-pill combination (SPC) of perindopril (SPC indapamide/perindopril and SPC amlodipine/indapamide/perindopril) (p = 0,003; p = 0,01). Based on the analysis, it was found that the presence of a family, higher education, income level, motivation and trust in doctors are significant factors that increase adherence to treatment. Conclusions. The problem of non-commitment has been and remains one of the most complex and difficult to solve. The main reason for low adherence among patients with AF with concomitant extracardiac diseases was polypharmacy, and it is associated with the use of a large number of drugs and a complex treatment regimen. Thus, the limitation of the use of fixed combinations is one of the main reasons for the lack of adherence and needs to be addressed soon.

Introduction. The coronavirus disease 2019 (COVID-19) pandemic has been going on for more than two years and is significantly affecting routine clinical practice. Despite the numerous publications on heart damage in the acute phase of COVID-19, there is not enough data regarding the dynamics of cardiovascular system condition in coronary artery disease (CAD) patients after the infection caused by SARS-CoV-2. The influence of the long-term consequences of the disease on cardiovascular system condition of patients who have had infection requires careful study. Aim. To assess the clinical and laboratory picture and coronary lesion nature in CAD patients with mild or moderate course of COVID-19 infection after at least 12 weeks. Materials and methods. The analysis of clinical, laboratory parameters and coronary angiography of 118 CAD patients aged 46–67 years (mean age 60.2 ± 6.1 years) after a serologically confirmed SARS-CoV-2 infection at the lapse of 12 weeks was carried out. The patients were divided into 2 groups: group 1 included 60 patients with a mild COVID-19, group 2 included 58 patients with a moderate COVID-19 course. Results. CAD patients with a moderate course of COVID-19 in the acute period had higher values of office blood pressure, higher incidence of uncontrolled arterial hypertension, major multivessel lesions of coronary arteries and lesions of the main vessels than CAD patients with mild COVID-19. When comparing echocardiographic parameters in patients with moderate COVID-19, the lower parameters of the left ventricular ejection fraction were found which is quite consistent with the higher NT-proBNP values in these patients. Conclusion. CAD patients, who have had moderate COVID-19 in the acute phase of infectious process, constitute a special risk group for a subsequent more severe course of the underlying disease.