Characteristics of NO-dependent autoregulation of tissual blood flow at idiopathic atrial fibrillation

Bockeriа, L.A.; Bockeria, O.L.; Bazarsadaeva, T.S.; Salia, N.T.; Donakanyan, S.A.; Биниашвили, М.Б.; Taskina, V.Yu.

doi:10.15275/annaritmol.2013.2.5

Cited by 2 publications

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“…ЧЖС -частота желудочковых сокращений. [10] было показано, что у пациентов с ФП старше 50 лет при длительности ФП более 5 лет, а также при тахисистолии желудочков наблюдается значительное снижение Vm, что на тканевом уровне увеличивает риск локального тромбообразования. В нашем исследовании адекватный контроль ЧЖС положительно влиял на показатели тканевой гемодинамики, полученные методом высокочастотной ультразвуковой допплеровской флоуметрии.…”

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“…Между тем, как показано в работе Л. А. Бокерия и соавт. [10], обнаруживая общие патологические тенденции, в первую очередь замедление дистального кровотока, удается получать объективные данные о повышенном риске локального тромбообразования. Замедление кровотока в терминальном звене сосудистой сети способствует повышению вязкости крови и возрастанию напряжения сдвига, являясь одной из причин развивающейся на фоне ФП дисфункции эндотелия.…”

Section: Discussionunclassified

“…Поиск новых направлений изучения указанной проблемы для оптимизации врачебных решений при контроле ЧЖС у больных с ФП приводит к необходимости оценки гемодинамики в терминальном звене сосудистой сети для выявления предпосылок к ишемическим нарушениям головного мозга [10], что особенно важно при ведении пациентов пожилого возраста. Кроме того, актуально изучение воздействия различных режимов терапии для контроля ЧЖС при ФП на показатели повреждения миокарда.…”

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Control of ventricular rate in permanent atrial fibrillation: cardioprotection and tissue hemodynamics

Kanorskiy

Polischuk

2020

Kardiologiia

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Objective To evaluate myocardial injury and tissue hemodynamics in elderly patients with permanent atrial fibrillation (AF) based on the achieved range of ventricular contraction rate (VCR).Materials and Methods This prospective, randomized, blind study included 75 patients aged ≥60 with permanent AF. All patients were prescribed bisoprolol as a VCR-reducing therapy. Patients were randomized to two groups according to the permuted-block design based on the range of resting VCR goal: group 1, 60–79 bpm (n=38) and group 2, 80–100 bpm (n=37). All patients also received perindopril and apixaban. Troponin I concentration was measured using the high-sensitivity assay (hsTn); parameters of tissue hemodynamics, including the mean blood flow velocity (Vm) and pulsatility index (PI), were measured using high-frequency ultrasound doppler flowmetry; echocardiographic indexes of left heart remodeling were recorded at baseline and after 6 month of VCR monitoring.Results Mean age of patients was 74±7 years. Medians [25th percentile; 75th percentile] of baseline hsTn concentrations were 10.2 [5.25; 21.2] ng / l in group 1 and 10.3 [5.4; 20.4] ng / ml in group 2 (p=0.91). 89.5 % of patients in group 1 and 100 % of patients in group 2 achieved the VCR range goal. At 6 month, resting VCRs were 70±4 bpm in group 1 (n=34) and 88±5 bpm in group 2 (n=37) (p1, p2<0.001). According to echocardiographic data significant progression of myocardial remodeling was not observed. Concentrations of hsTn significantly decreased in both groups but the decrease was more pronounced in group 1, to 8.0 [4.13; 17.23; p1<0.001] ng / l vs. 9.2 [4.8, 17.5] ng / l in group 2 (р1, p2<0.001). A weak direct correlation was found between the VCR decrease and hsTn concentration (rs=0.44; p=0.009 in group 1, and rs=0.41; p=0.01 in group 2); regression coefficient was 0.78 at 95 % confidence interval (CI), from 0.21 to 1.3 (p=0.009) in group 1, and 0.14 at 95 % CI, from 0.04 to 0.24 (p=0.007) in group 2. Vm values were increased to 2.93±0.10 (p<0.001) and 3.21±0.09 cm / sec (p<0.001) and PIs were decreased to 1.42±0.03 conv. units (p<0.01) and to 1.34±0.02 conv. units (p<0.001) in groups 1 and 2, respectively.Conclusion The treatment aimed at VCR control in patients older than 60 with permanent AF was associated with a positive dynamics of myocardial injury (hsTn) and tissue hemodynamics indexes (Vm и РI). This indicates a possibility for using these indexes for further improvement of managing such patients.

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Control of ventricular rate in permanent atrial fibrillation: cardioprotection and tissue hemodynamics

Kanorskiy

Polischuk

2020

Kardiologiia

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Parameters used in the control of ventricular rate in patients with permanent atrial fibrillation

Канорский

Polischuk

2020

Vestnik aritmologii

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Purpose. To analyze the possibility of using high-sensitivity cardiac troponin I (hsTnI), N-terminal pro-B type natriuretic peptide (NT-proBNP), tissue hemodynamics parameters, echocardiographic data and the quality of life for selection of the individual regimen for ventricular rate (VR) control drug therapy in patients with permanent atrial fibrillation (AF). Methods. The study included 120 patients aged >60 years old with the diagnosis of permanent AF, who gave the informed consent. Patients were randomized into 2 groups according to the target range of VR at rest: 60-79 bpm (first group, n=60) and 80-100 bpm (second group, n=60). Patients in both groups were prescribed a selective beta1 -adrenoceptors blocker bisoprolol for VR control. The following parameters were determined before randomization and after 6 months of VR control in the target ranges: atrial and ventricular remodeling with transthoracic echocardiography; biochemical markers hsTnI and NT-proBNP; the tissue hemodynamics by the mean flow velocity (Vm) and the value of the pulsatility index (PI) using high-frequency ultrasound Doppler flowmetry; the patients’ quality of life with the “Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) Questionnaire” and the “EQ-5D-5L” system with a scale EQ-VAS.Results. VR at rest after 6 months was 70±3 and 88±4 bpm (p1, p2˂0.001) in the first and second groups, respectively (p1 - comparing the initial and achieved values, p2 - values of the first and second groups). The level of hsTnI significantly decreased in both groups, but it was more pronounced in the 60-79 bpm range group (p˂0.001). Spearman’s correlation coefficients between the degree of decrease in VR and decrease in the level of hsTnI were 0.45 (p˂0.001) and 0.44 (p˂0.001) in the first and second groups, respectively. AFEQT and EQ VAS scores of quality of life improved after 6 months in both groups: the increase in the total AFEQT score in the first group -56.2±17.0% (M±SD), in the second - 42.6±15.3% (p˂0.001); EQ VAS values also increased, but differences between groups were not significant (p=0.078). In both the first and second groups, a strong positive correlation was found between the degree of decrease in VR and increase in the total score of the AFEQT questionnaire. The tendency toward an increase in Vm and a decrease in PI observed in both groups was more pronounced in the group with VR of 80-100 bpm, where Vm increased by more than 10% (p1, p2˂0.001). Changes in NT-proBNP under the influence of therapy for the reported observation period did not reach statistical significance in both groups (p1 =0.092, p2 =0.063). There was no significant dynamics of echocardiographic parameters of myocardial remodeling.Conclusion. The degree of chronic myocardial damage caused by arrhythmia (estimated by hsTnI), as well as the tissue hemodynamic parameters Vm and PI, can be the basis for individualized selection of the target VR range. This approach will allow to find a balance between cardioprotection and improvement of tissue blood flow. In creating the algorithm of selecting the target VR for patients older than 60 years with permanent AF, it is advisable to use such parameter as the degree of the initial VR change and quality of life data from the “AFEQT Questionnaire”.

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Characteristics of NO-dependent autoregulation of tissual blood flow at idiopathic atrial fibrillation

Cited by 2 publications

References 15 publications

Control of ventricular rate in permanent atrial fibrillation: cardioprotection and tissue hemodynamics

Control of ventricular rate in permanent atrial fibrillation: cardioprotection and tissue hemodynamics

Parameters used in the control of ventricular rate in patients with permanent atrial fibrillation

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Characteristics of NO-dependent autoregulation of tissual blood flow at idiopathic atrial fibrillation

Cited by 2 publications

References 15 publications

Control of ventricular rate in permanent atrial fibrillation: cardio­protec­tion and tissue hemodynamics

Control of ventricular rate in permanent atrial fibrillation: cardio­protec­tion and tissue hemodynamics

Parameters used in the control of ventricular rate in patients with permanent atrial fibrillation

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Control of ventricular rate in permanent atrial fibrillation: cardioprotection and tissue hemodynamics

Control of ventricular rate in permanent atrial fibrillation: cardioprotection and tissue hemodynamics