cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2012-4-16-22cardiovascular-1861Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАCORONARY HEART DISEASEВзаимосвязь омега-3 индекса эритроцитов с предикторами внезапной сердечной смерти у пациентов с ишемической болезнью сердца и желудочковыми аритмиямиOmega-3 index of erythrocytes and predictors of sudden cardiac death in patients with coronary heart disease and ventricular arrhythmiasГавваЕ. М.GavvaE. M.

(контактное лицо) – аспирант кафедры факультетской терапии №1 лечебного факультета

Тел.: 8-917-570-83-64, (495) 248-45-23,факс: (499) 248-45-23

katerina83@inbox.ruЦарегородцевД. А.TsaregorodtsevD. A.

доцент этой кафедры

Тел.: 8-917-570-83-64, (495) 248-45-23,факс: (499) 248-45-23

katerina83@inbox.ruМамедовИ. С.MamedovI. S.

заведующий лабораторией федерального центра неонатального скрининга наследственных заболеваний у детей

Тел.: 8-917-570-83-64, (495) 248-45-23,факс: (499) 248-45-23

katerina83@inbox.ruСулимовВ. А.SulimovV. A.

заведующий кафедрой

Тел.: 8-917-570-83-64, (495) 248-45-23,факс: (499) 248-45-23

katerina83@inbox.ruПервый Московский государственный медицинский университет им. И. М. Сеченова Минздравсоцразвития России, МоскваI. N. Sechenov First Moscow State Medical University, MoscowМосковский научно-исследовательский институт педиатрии и детской хирургии, МоскваMoscow Research Institute of Pediatrics and Pediatric Surgery, Moscow2012200820121141622Copyright © Гавва Е.М., Царегородцев Д.А., Мамедов И.С., Сулимов В.А., 20122012Гавва Е.М., Царегородцев Д.А., Мамедов И.С., Сулимов В.А.Gavva E.M., Tsaregorodtsev D.A., Mamedov I.S., Sulimov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1861

Цель. Оценить взаимосвязь между ω-3 индексом эритроцитов и демографическими, электрофизиологическими и эхокардиографическими (ЭхоКГ) предикторами внезапной сердечной смерти (ВСС) у больных ишемической болезнью сердца (ИБС) и желудочковыми нарушениями ритма (ЖНР). Материал и методы. В исследование включены 25 больных с доказанной ИБС и ЖНР. Методом газовой хроматографии определялось процентное содержание эйкозапентаеновой (ЭПК), докозагексаеновой (ДГК) полиненасыщенных жирных кислот (ПНЖК) и их сумма – ω-3 индекс в эритроцитах периферической крови. Всем пациентам выполняли суточное мониторирование электрокардиограммы (СМ ЭКГ) с оценкой максимальной, минимальной и средней частоты сердечных сокращений (ЧСС), показателей вариабельности ритма сердца (ВСР) – SDNN и pNN50, турбулентности ритма сердца (ТСР) – TO и TS, а также микровольтной альтернации зубца Т (mTWA) с определением количества ЖЭ, пароксизмов устойчивой и неустойчивой желудочковой тахикардии (ЖТ). Всем пациентам проводилось ЭхоКГ исследование. Результаты. Значения ω-3 индекса эритроцитов у обследованных пациентов колебались от 1,12% до 6,4%, составляя в среднем 3,74 % [2,02; 4,38]. Выявлена слабая прямая корреляционная связь между ω-3 индексом эритроцитов, а также долей ЭПК и показателем ВСР pNN50 и обратная связь ω-3 индекса и доли ДГК с числом ЖЭ за сут. Значение mTWA в 5 ч, оцененное во втором мониторном отведении при факторе актуализации 1/8, характеризовалось слабой положительной связью с ω-3 индексом и ДГК. Отношение максимальных скоростей раннего и позднего диастолического наполнения левого желудочка (Е/А) характеризовалось прямой связью средней силы с омега-3 индексом, содержанием ЭПК и ДГК. Заключение. Пациенты с ИБС и ЖНР характеризуются низким ω-3 индексом эритроцитов, соответствующим высокому (у 56%) и среднему (у 44%) риску сердечно-сосудистых осложнений. ω-3 индекс эритроцитов обратно коррелирует с числом ЖЭ за сут. и прямо – с показателем ВРС (pNN50) и Е/А.

Aim. To assess the association between ω-3 index of erythrocytes and demographic, electrophysiological, and echocardiographic (EchoCG) predictors of sudden cardiac death (SCD) in patients with coronary heart disease (CHD) and ventricular arrhythmias (VA). Material and methods. The study included 25 patients with a verified diagnosis of CHD and VA. Gas chromatography method was used to measure the content (%) of eicosapentaenoic (EPA) and docosahexaenoic (DHA) polyunsaturated fatty acids (PUFA) in peripheral blood erythrocytes, with the calculation of a summary (EPA + DHA) ω-3 index. All participants underwent 24-hour electrocardiography (ECG) monitoring, with the assessment of maximal, minimal, and mean heart rate (HR), heart rate variability (HRV) parameters (SDNN and pNN50), heart rate turbulence (TO and TS), microvolt T wave alternans (mTWA), and the number of ventricular extrasystoles (VE) and transient and persistent ventricular tachycardia (VT) episodes. All patients also underwent EchoCG. Results. In examined patients, the values of ω-3 index of erythrocytes varied from 1,12% to 6,4% (mean 3,74%, 95% CI 2,02-4,38%). There was a weak correlation between ω-3 index or EPA levels (%) and the HRV parameter of pNN50. In addition, ω-3 index or DHA levels (%) negatively correlated with the daily VE number. The 5:00 AM value of mTWA (II lead, update factor 1/8) weakly correlated withω-3 index and DHA levels. There was a moderate positive correlation between E/A ratio and omega-3 index, or EPA and DHA levels. Conclusion. Patients with CHD and VA were characterised by low ω-3 index values and high (56%) or moderate (44%) levels of cardiovascular risk. The values of ω-3 index positively correlated with the daily VE number and negatively correlated with E/A ratio and pNN50 parameter of HRV.

омега-3 полиненасыщенные жирные кислотывариабельность ритма сердцатурбулентность ритма сердцамикровольтная альтернация зубца Тишемическая болезнь сердцавнезапная сердечная смертьomega-3 polyunsaturated fatty acidsheart rate variabilityheart rate turbulencemicrovolt T wave alternanscoronary heart diseasesudden cardiac deathReferencesACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). JACC 2006; 48: 1064-108.ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). JACC 2006; 48: 1064-108.GISSI-HF Investigators, Tavazzi L, Maggioni AP, Marchioli R, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372(9645): 1223-30.GISSI-HF Investigators, Tavazzi L, Maggioni AP, Marchioli R, et al. Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372(9645): 1223-30.ACC/AHA/ESC guidelines for management of patients with ventricular arrhythmias and prevention of sudden cardiac death. Europace 2006; 8: 746-837.ACC/AHA/ESC guidelines for management of patients with ventricular arrhythmias and prevention of sudden cardiac death. Europace 2006; 8: 746-837.Mozaffarian D, Prineas RJ, Stein PK, Siscovick DS. Dietary fish and n-3 fatty acid intake and cardiac electrocardiographic parameters in humans. JACC 2006; 48: 478-84.Mozaffarian D, Prineas RJ, Stein PK, Siscovick DS. Dietary fish and n-3 fatty acid intake and cardiac electrocardiographic parameters in humans. JACC 2006; 48: 478-84.Aarsetoey H, Aarsetoey R, Lindner T, et al. Low Levels of the Omega-3 Index are Associated with Sudden Cardiac Arrest and Remain Stable in Survivors in the Subacute Phase. Lipids 2011; 46(2): 151-61.Aarsetoey H, Aarsetoey R, Lindner T, et al. Low Levels of the Omega-3 Index are Associated with Sudden Cardiac Arrest and Remain Stable in Survivors in the Subacute Phase. Lipids 2011; 46(2): 151-61.Harris WS, von Schacky C. The omega-3 index: a new risk factor for death from coronary heart disease? Prev Med 2004; 39(1): 212-20.Harris WS, von Schacky C. The omega-3 index: a new risk factor for death from coronary heart disease? Prev Med 2004; 39(1): 212-20.Harris WS, von Schacky C. Omega-3 Fatty Acids, Acute Coronary Syndrome, and Sudden Death. Curr Cardiovasc Risk Reporets 2008; 2(2): 161-6.Harris WS, von Schacky C. Omega-3 Fatty Acids, Acute Coronary Syndrome, and Sudden Death. Curr Cardiovasc Risk Reporets 2008; 2(2): 161-6.Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274(17): 1363-7.Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274(17): 1363-7.Mozaffarian D, Lemaitre RN, Kuller LH, et al. Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation 2003; 107(10): 1327-72.Mozaffarian D, Lemaitre RN, Kuller LH, et al. Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation 2003; 107(10): 1327-72.Chattipakorn N, Settakorn J, Petsophonsakul P, et al. Cardiac mortality is associated with low levels of omega-3 and omega-6 fatty acids in the heart of cadavers with a history of coronary heart disease. Nutr Res 2009; 29(10): 696-704.Chattipakorn N, Settakorn J, Petsophonsakul P, et al. Cardiac mortality is associated with low levels of omega-3 and omega-6 fatty acids in the heart of cadavers with a history of coronary heart disease. Nutr Res 2009; 29(10): 696-704.Harris WS, Sands SA, Windor SL, et al. Omega-3 fatty acids in cardiac biopsies from heart transplantation patients: correlation with erythrocytes and response to supplementation. Circulation 2004; 110(12): 1645-9.Harris WS, Sands SA, Windor SL, et al. Omega-3 fatty acids in cardiac biopsies from heart transplantation patients: correlation with erythrocytes and response to supplementation. Circulation 2004; 110(12): 1645-9.Leaf A, Albert CM, Josephson M, et al, for the Fatty Acid Antiarrhythmia Trial Investigators. Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 2005; 112(18); 2762-8.Leaf A, Albert CM, Josephson M, et al, for the Fatty Acid Antiarrhythmia Trial Investigators. Prevention of fatal arrhythmias in high-risk subjects by fish oil n-3 fatty acid intake. Circulation 2005; 112(18); 2762-8.Leaf A, Xiao YF, Kang JX, Billman GE. Membrane effects of the n-3 fish oil fatty acids, which prevent fatal ventricular arrhythmias. J Membr Biol 2005; 206(2): 129-39.Leaf A, Xiao YF, Kang JX, Billman GE. Membrane effects of the n-3 fish oil fatty acids, which prevent fatal ventricular arrhythmias. J Membr Biol 2005; 206(2): 129-39.Raitt MH, Connor WE, Morris C, et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 2005; 293(23): 2884-91.Raitt MH, Connor WE, Morris C, et al. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial. JAMA 2005; 293(23): 2884-91.Morris MC, Manson JE, Rosner B, et al. Fish consumption and cardiovascular disease in the physicians’ health study: a prospective study. Am J Epidemiol 1995; 142(2): 166-75.Morris MC, Manson JE, Rosner B, et al. Fish consumption and cardiovascular disease in the physicians’ health study: a prospective study. Am J Epidemiol 1995; 142(2): 166-75.Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002; 346(15): 1113-8.Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002; 346(15): 1113-8.Christensen JH, Gustenhoff P, Korup E, et al. Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomized controlled trial. Br Med J 1996; 312: 677-8.Christensen JH, Gustenhoff P, Korup E, et al. Effect of fish oil on heart rate variability in survivors of myocardial infarction: a double blind randomized controlled trial. Br Med J 1996; 312: 677-8.O’Keefe JH Jr, Abuissa H, Sastre A, et al. Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions. Am J Cardiol 2006; 97: 1127-30.O’Keefe JH Jr, Abuissa H, Sastre A, et al. Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions. Am J Cardiol 2006; 97: 1127-30.Gavva E, Tsaregorodtsev D, Mamedov I, et al. Omega-3-index erythrocytes as index reflecting the content of omega-3 polyunsaturated fatty acids in biomembranes of cardiomyocytes. Abstract book EuroPRevent 2011 Geneva, Switzerland. С. S92 (№ 346).Gavva E, Tsaregorodtsev D, Mamedov I, et al. Omega-3-index erythrocytes as index reflecting the content of omega-3 polyunsaturated fatty acids in biomembranes of cardiomyocytes. Abstract book EuroPRevent 2011 Geneva, Switzerland. С. S92 (№ 346).Okisheva EA, Tsaregorodtsev DA, Sulimov VA. Holter monitoring capabilities in assessing microvolt T-wave alternans and heart rate turbulence in patients after myocardial infarction. Ultrasound and Functional Diagnostics 2011; 3: 59-70. Russian (Окишева Е.А., Царегородцев Д.А., Сулимов В.А. Возможности холтеровского мониторирования в оценке микровольтной альтернации зубца Т и турбулентности ритма сердца у больных, перенесших инфаркт миокарда. Ультразвук функц диагн 2011; 3: 59-70).Okisheva EA, Tsaregorodtsev DA, Sulimov VA. Holter monitoring capabilities in assessing microvolt T-wave alternans and heart rate turbulence in patients after myocardial infarction. Ultrasound and Functional Diagnostics 2011; 3: 59-70. Russian (Окишева Е.А., Царегородцев Д.А., Сулимов В.А. Возможности холтеровского мониторирования в оценке микровольтной альтернации зубца Т и турбулентности ритма сердца у больных, перенесших инфаркт миокарда. Ультразвук функц диагн 2011; 3: 59-70).International Omega-3 learning and education consortium for health and medicine. University of Connecticut 2007-2012. http://www.omega3learning.uconn.edu/library/International Omega-3 learning and education consortium for health and medicine. University of Connecticut 2007-2012. http://www.omega3learning.uconn.edu/library/

The authors declare that there are no conflicts of interest present.