Echo-cardiographic parameters for atrial fibrillation in combination with acute coronary syndrome in real clinical practice according to register of acute coronary syndrome in the Krasnodar region

Aim. To evaluate patients with acute coronary syndrome (ACS) in combination with atrial fibrillation (AF) according to the total register of ACS in the Krasnodar region of echocardiographic (EchoCG) parameters (left atrial dimension (LAD), left ventricular wall thickness (LVWT), left ventricle end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), as well as coronary substrate assessment according to coronary angiography (CAG) and determination of the relationship between the value of LVEF and the coronary substrate.

Material and methods. From the register of the ACS in the Krasnodar region, patients were successively taken to the cardiology departments of Krasnodar regional clinical hospital № 1 for the period from November 20, 2015 to November 20, 2017 with a diagnosis of ACS, accompanied by one of the types of atrial fibrillation. This group of patients was designated as a group of ACS + AF and amounted to 119 patients. The comparison group was selected with the help of a random number generator from patients admitted to the hospital with ACS and intact sinus rhythm (SR) for the period of time from November 20, 2015 to November 20, 2017 (120). We analyzed the ECHO-CG parameters, the coronary substrate — according to the CAG.

Results. When comparing the cohort of patients with ACS + AF with the cohort of patients with ACS + SR, we determined a significant (p<0,05) difference of LA size, LVEF and values of PASP. During comparing the presence of hemodynamically significant stenosis in the coronary arteries we noticed that in ACS + AF patients with LVEF <40% in significantly higher percentage of cases (p=0,0007) occurs significant hemodynamic stenosis of coronary arteries, in contrast to the group of patients with ACS + SR with LVEF <40%. In patients with EF >40% and ACS + SR we determined a significantly more frequent (p<0,001) stenosis.

Conclusion. The results of the analysis are important for understanding the distinguishing characteristics of patients with ACS that occur on the background of AF, which is important for correct prediction of the course of the disease. The maintenance of the ACS register will provide information on the real clinical course of the disease, as well as improve the effectiveness of treatment in real clinical practice.

1. Chaga SS, Havmoeller R, Narayanan K, Sing D, et al. World epidemiology of atrial fibrillation: a global burden of disease research, 2010. Circulation. 2014;129:837-47. doi:10.1161/CIRCULATIONAHA.113.005119.

2. Miyasaka Y, Barnes ME, Bailey KR, et al. Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. JACC. 2007;49:986-92. doi:10.1016/j.jacc.2006.10.062.

3. Soliman EZ, Lopez F, O'Neal WT, et al. Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2015;131(21):1843-50. doi:10.1161/CIRCULATIONAHA.114.014145.

4. Soliman EZ, Safford MM, Muntner P, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med. 2014;174:107-14. doi: 10.1001/jamainternmed.2013.11912.

5. Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. 2011;123:1587-93. doi:10.1161/CIRCULATIONAHA.110.986661. Epub 2011.

6. Jabre P, Jouven X, Adnet F, et al. Atrial fibrillation and death after myocardial infarction: a community study. Circulation. 2011;123:2094-100. doi:10.1161/CIRCULATIONAHA.110.990192. Epub 2011.

7. Schmitt J, Duray G, Gersh BJ, et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30:1038-45. doi:10.1093/eurheartj/ehn579. Epub 2008.

8. Shulman VA, Shesternya PA, Golovenkin SE, et al. Atrial fibrillation in patients with myocardial infarction: predictors of occurrence, impact on the nearest and longterm prognosis. Herald of arrhythmology. 2005;39:5-9. (In Russ.)

9. Lippi G, Picanza A, Formentini A, et al. The concentration of troponin I is increased in patients with acute-onset atrial fibrillation. Int J Cardiol. 2014;173:579-80. doi:10.1016/j.ijcard.2014.03.113. Epub 2014.

10. Lang RM, Bierig M, Devereux RB, et al. Recommendations for the quantification of chambers: a report of the Committee on Standards and Standards of the American Society for the Assessment of Echocardiography and the Chamber's quantitative assessment team, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440-63.

11. McCullough PA, Gibson CM, Dibattiste PM, et al. Timing of angiography and revascularization in acute coronary syndromes: an analysis of the TACTICS-TIMI-18 trial. J Interv Cardiol. 2004;17(2):81-6. doi:10.1111/j.1540-8183.2004.021001.x.

12. Bahouth F, Mutlak D, Furman M, et al. Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction. Heart. 2010;96:683-8. doi:10.1136/hrt.2009.183822.

13. Aronson D, Mutlak D, Bahouth F, et al. Restrictive left ventricular filling pattern and risk of new-onset atrial fibrillation after acute myocardial infarction. Am J Cardiol. 2011;107:1738-43. doi:10.1016/j.amjcard.2011.02.334. Epub 2011.