Changes in clinical indicators and state of the coagulation hemostasis in patients with newly diagnosed atrial fibrillation and metabolic syndrome

Abstract

Introduction. Atrial fibrillation (AF) is the most common persistent cardiac arrhythmia, with an incidence of 1-2% in the general population. Among the main links of the pathogenesis of AF of non-rheumatic etiology is the loss of antithrombogenic properties by the endothelium and an increase in the coagulation potential of blood with the formation of persistent chronic hypercoagulation. The goal is to evaluate the state of coagulation hemostasis and clinical indicators in patients with newly diagnosed atrial fibrillation (NDAF) and metabolic syndrome (MS) depending on the insulin level in the blood, the form and type of AF paroxysms. Material and methods. The clinical symptoms of 127 patients with AF and MS were assessed according to the EHRA scale and Holter monitoring of the electrocardiogram (HM ECG) was performed with the determination of the type of AF paroxysm and heart rate variability (HRV), the state of coagulation hemostasis was assessed using the prothrombin index (PTI), fibrinogen, soluble fibrin-monomeric complexes (SFMC), D-dimers depending on the EI level and the form of AF in the conditions of the oral glucose tolerance test (OGTT). The results. In patients with AF and MS, insulin resistance (IR) is manifested by reactive and spontaneous hyperinsulinemia (HI) with an increase of the EI level in conditions of OGTT. Typical complaints of AF according to the EHRA scale are associated with a more pronounced level of HI and a higher heart rate. Prothrombotic disorders of the coagulation link of hemostasis are manifested by increased levels of PtI, fibrinogen and fibrin degradation products — SFMK, D-dimers in 72% of patients with paroxysmal AF, in 84% — in persistent AF, and in 86% — in permanent AF. The highest levels of the coagulation indicators link were found in patients with spontaneous HI. Conclusions. Under IR with reactive and spontaneous HI, in 70% of cases of patients with NDAF, a permanent form of AF is formed with a progressive increase in the risk of thrombotic complications according to indicators of the coagulation hemostasis link, an increase in complaints associated with arrhythmia according to the EHRA scale, and a predominance of the adrenergic type of the AF paroxysm course with formation an imbalance between sympathetic and parasympathetic links of the autonomic nervous system.