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Abstract
The goal — to evaluate the relationship between the indices of the renin-angiotensinaldosterone system (RAAS) and systemic inflammation with the heart rate variability (HRV) and endogenous insulin (EI) in patients with new-onset atrial fibrillation (AF) and metabolic syndrome (MS). Material and methods. A total of 107 patients (62 male, 45 female; age: 66 ± 10 years) with new-onset AF and MS according to the criteria of ATP III (2001) and heart failure (HF) functional class (FC) I-II NYHA. Depending on the EI levels patients were divided into 3 groups. Group 1 consisted of 42 patients with normal EI levels in the blood; group 2 — 29 patients with reactive hyperinsulinemia (HI); group 3 — 36 patients with spontaneous HI. An oral glucose tolerance test (OGTT) with parallel determination of glucose (glucose oxidase method), EI, C-reactive protein (C-RP) and circulating plasma aldosterone (enzyme immunoassay), Holter monitoring electrocardiogram (ECG HM) with the assessment temporary HRV were measured. Control group consisted 20 healthy individuals of appropriate ages. Results and discussion. Circulating aldosterone and C-RP levels were significantly increased in patients with reactive / spontaneous HI, as evidenced by the presence of a direct correlation between the EI and aldosterone levels (r=+0.8701, p=0.0011 / r=+0.8733, p=0.0004), EI and C-RP (r=+0.7215, p=0.0035 / r=+0.7627, p=0.0015). Under reactive / spontaneous HI we revealed a strong direct correlation between the aldosterone levels and heart rate (HR) (r=+0.7140, p=0.0028), aldosteron and SDANN (r=+0.8381, p=0.00010) and a negative correlation between the aldosterone levels and RMSSD (r=–0.6263, p=0.0125), aldosterone and pNN50 (r=–0.8434, p=0.00008). During the correlation analysis between the temporal parameters of HRV and chronic systemic inflammation marker C-RP there were
showed a strong direct relationship between C-RP levels and HR (r=+0.7253, p=0.0024), a moderate direct connection between C-RP and SDANN (r=+0.3672, p=0.0044), a strong negative relationship between C-RP and RMSSD (r=–0.7029, p=0.0034), between C-RP and pNN50 (r=–0.8220, p=0.00018) under HI. Conclusion. At the patients with new-onset AF and initial stages of HF and insulin resistance humoral markers of endothelial dysfunction the C-RP and circulating aldosterone significantly are increased, as evidenced by the presence of a strong direct correlation between the aldosterone and EI levels and between C-RP and EI levels. Increased activity of the RAAS with hyperaldosteronemia is accompanied by a decreasing in the parasympathetic nervous system influences on the sinus node, and contributes to the progression of AF in patients with insulin resistance and HF FC I-II.
References
Діагностика та лікування фібриляції передсердь. Рекомендації робочої групи по порушенням серцевого ритму Асоціації кардіологів України / ОС Сичов, ВМ Коваленко, ГВ Дзяк [та ін.]. К., 2015:27-30.
2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society / Craig T January, L Samuel Wann, Julie B Shea, Cynthia M Tracy, Clyde W Yancy. Published: January 28, 2019. DOI: https://doi.org/10.1016/j.hrthm.2019.01.024
Obesity and atrial fibrillation outcomes and risk: Increasing the weight of evidence / Chrishan J Nalliah, Prashanthan Sanders, Jonathan M Kalman. Published: March 16, 2017. DOI: https://doi.org/10.1016/j.hrthm.2017.03.013
Псарьова ВГ. Особливості активності окремих компонентів ренін-ангіотензин-альдостеронової системи при гіпертонічній хворобі та супутньому ожирінні. Український журнал медицини, біології та спорту. 2017;4(2),18:62-68. DOI: 10.26693/jmbs04.02.168
Степанова ЕВ. Роль ожирения и ренин-ангиотензин-альдостероновой системы в генезе инсулинорезистентности, метаболического синдрома и резистентной гипертензии / ЕВ Степанова, НА Кравченко. Український терапевтичний журнал. 2011.4:105-112.
Evidence for a Causal Role of the Renin-Angiotensin System in Vascular Dysfunction Associated With Insulin Resistance / Kazuya Shinozaki, Kazuhide Ayajiki, Yoshihiko Nishio [et al.]. J. Hypertension. 2014;43:255-262.
Sleep characteristics that predict atrial fibrillation / Matthew A Christensen, Shalini Dixit, Thomas A Dewland, Mark J Pletcher, Susan R Heckbert, Gregory M Marcus. Published: June 25. 2018. DOI: https://doi.org/10.1016/j.hrthm.2018.05.008
Рибальченко ІЮ. Варіабельність серцевого ритму на епізодах фібриляції передсердь у різних класах тривалості комплексу QRS ЕКГ при терапії пацієнтів із постійною, пароксизмальною та персистентною фібриляцією передсердь / ІЮ Рибальченко, НВ Макієнко, ЕП Каменська. Медицина транспорту України. 2011;2:53-58.
Ткаченко ВІ. Метаболічний синдром: діагностика та профілактика в практиці сімейного лікаря / ВІ Ткаченко, ТО Багро, НВ Видиборець, ОК Бондар. Ліки України. 2016. 1-2(197-198):43-46.
Molecular Mechanisms and New Treatment Paradigm for Atrial Fibrillation / Padmini Sirish, Ning Li, Valeriy Timofeyev, Xiao-Dong Zhang, Lianguo Wang, Jun Yang, Kin Sing, Stephen Lee, Ahmed Bettaieb, Sin Mei Ma, Jeong Han Lee, Demetria Su Originally published May 2016. https://doi.org/10.1161/CIRCEP.115.003721Circulation: Arrhythmia and Electrophysiology. 2016;9: e003721
Фуштей ІМ. Інфламаторна активація у хворих з фібриляцією передсердь / ІМ Фуштей, БМ Голдовський, ЄВ Сідь. Медицина невідкладних станів. 2012;2(41):34-38.
C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation / MK Chung, DO Martin, D Sprecher et al. Circulation. 2016;104:2886-2891.
Altered heart rate variability in angiotensin II — mediated hypertension is associated with impaired autonomic nervous system signaling and intrinsic sinoatrial node dysfunction / TW Dorey, et al. Heart Rhythm. 2017;17(8):1360-1370.
Systematic review of biological therapies for atrial fibrillation / Callum McRae, Anshul Kapoor, Pushpinder Kanda, Benjamin Hibbert, Darryl R Davis. Published: March 27, 2019. DOI: https://doi.org/10.1016/j.hrthm.2019.03.021 УДК 616.151.5+616-008+616.12-008.331.1+616.12-008.313