ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket12729ketendo-12729Research ArticleОригинальные исследованияOriginal StudiesФакторы, ассоциированные с исходами тиреотоксической фибрилляции предсердий.Factors, associated with the outcomes of the thyrotoxic atrial fibrillationhttps://orcid.org/0000-0002-0434-7808ПономарцеваД. А.PonomartsevaD. A.

Пономарцева Дарья Александровна - врач-эндокринолог эндокринологического отделения; eLibrary SPIN: 2111-6476.

194156, Санкт-Петербург, проспект Пархоменко, д. 15

Daria A. Ponomаrtseva; eLibrary SPIN: 2111-6476

15 Parhomenko prospekt, 194156 Saint Petersburg

Savitskayadaria@gmail.comhttps://orcid.org/0000-0002-0559-697XБабенкоА. Ю.BabenkoA. Yu.

Бабенко Алина Юрьевна - доктор медицинских наук, профессор; руководитель научно-исследовательского отдела генетических рисков и персонифицированной профилактики, заведующий научно-исследовательской лабораторией предиабета и метаболических нарушений Научного центра мирового уровня «Центр персонализированной медицины», заведующий научно-исследовательской лабораторией диабетологии, профессор кафедры внутренних болезней Института медицинского образования, ФГБУ "НМИЦ им. В. А. Алмазова"; eLibrary SPIN: 9388-1077.

Санкт-Петербург

 

Alina Yu. Babenko - MD, PhD, Professor; eLibrary SPIN: 9388-1077

Saint Petersburg

alina_babenko@mail.ruНациональный медицинский исследовательский центр им. В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202224122022182416Copyright © Пономарцева Д.А., Бабенко А.Ю., 20222022Пономарцева Д.А., Бабенко А.Ю.Ponomartseva D.A., Babenko A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/12729ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Тиреотоксическая фибрилляция предсердий (ТФП) ассоциирована с повышением общей и сердечно-сосудистой смертности, в основном за счет развития тромбоэмболических осложнений. Поэтому профилактика тромбоэмболии является важным компонентом терапии пациентов с ТФП, и выявление факторов, ассоциированных с высоким риском тромбоэмболических событий на фоне ТФП, представляется интересным.

ТФП — потенциально обратимое состояние. Тем не менее восстановление синусового ритма после достижения эутиреоза происходит не у всех пациентов. Частота госпитализации по поводу сердечно-сосудистой патологии и фибрилляции предсердий (ФП), в частности у пациентов с тиреотоксикозом в анамнезе, выше, чем в общей популяции, даже после радикального лечения тиреотоксикоза.

Создание инструментов прогнозирования вышеперечисленных осложнений и неблагоприятных исходов ТФП позволит увеличить качество клинических рекомендаций по ведению пациентов с ТФП. При этом предикторы как тромбоэмболических событий на фоне ТФП, так и сохранения ТФП в настоящее время изучены недостаточно.

ЦЕЛЬ

ЦЕЛЬ. Целью настоящего исследования было выявить факторы риска неблагоприятных исходов ТФП: тромбоэмболических событий и отсутствия спонтанного восстановления синусового ритма после достижения эутиреоза.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. В исследование ретроспективно были включены 70 пациентов в возрасте от 24 до 70 лет с манифестным тиреотоксикозом и ТФП. У всех участников анализировались: тромбоэмболические события на фоне ТФП, наличие восстановления синусового ритма после купирования тиреотоксикоза и потенциально ассоциированные с ними параметры: ряд клинико-демографических факторов, данные эхокардиографии и характеристики течения ФП. С помощью регрессионного анализа проводилось изучение влияния этих потенциальных предикторов на риск тромбоэмболии и сохранения ТФП. Точки отсечения для выявленных факторов риска определялись с помощью построения ROC-кривых (ROC — receiver operating characteristic).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Проведенный анализ показал, что единственным независимым предиктором тромбоэмболических осложнений ТФП является большой диаметр левого предсердия (>4,3 см), а предикторами сохранения ТФП после достижения эутиреоза — большой конечно-диастолический размер левого желудочка (>4,5 см) и наличие дилатации левого предсердия.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. В настоящем исследовании выявлены эхокардиографические параметры, ассоциированные с тромбоэмболическими осложнениями ТФП и сохранением ТФП после достижения эутиреоза. Это может быть полезно для создания в перспективе инструментов прогнозирования неблагоприятных исходов ТФП.

BACKGROUND

BACKGROUND: Thyrotoxic atrial fibrillation (TAF) is associated with an increase in total and cardiovascular mortality, mainly due to the thromboembolic events. Therefore, thromboembolism prevention is an important TAF treatment component. Thus, it seems interesting to identify TAF thromboembolic complications predictors.

TAF is a potentially reversible state. However, the spontaneous reversion to sinus rhythm after the euthyroidism achievement does not occur in all patients. In patients with a history of thyrotoxicosis the hospitalization rate due to cardiovascular pathology, and due to atrial fibrillation (AF), in particular, is higher than in the general population, even after the radical treatment of thyrotoxicosis.

The development of prediction tools for mentioned above TAF complications and adverse outcomes, would make it possible to create more detailed and high-quality guidelines for the management of patients with thyrotoxicosis-induced AF. At the same time, the predictors of TAF thromboembolic complications and TAF maintenance after the euthyroid state is achieved, are not well currently understood.

AIM

AIM: The purpose of this study was to identify risk factors for TAF adverse outcomes: thromboembolic events and the lack of spontaneous reversion to sinus rhythm after the euthyroidism was achieved.

MATERIALS AND METHODS

MATERIALS AND METHODS: This is a retrospective study of 70 patients aged 24 to 70 years with a history of overt thyrotoxicosis and TAF. The following parameters were analyzed in all participants: thromboembolic events due to TAF, the presence of the spontaneous reversion to sinus rhythm after the euthyroidism was achieved and potentially associated with TAF adverse outcomes factors: a number of clinical and demographic factors, echocardiography data and characteristics of the TAF course. Regression analysis was performed to study the effect of these potential predictors on the risk of the thromboembolism and TAF maintenance. The cut-off points for the identified risk factors were determined by receiver operating characteristic (ROC) curves creating.

RESULTS

RESULTS: The analysis showed that the only independent TAF thromboembolic complications predictor among studied parameters was the large left atrium diameter (>4.3 cm), and the predictors of TAF maintenance after the euthyroid state is achieved included the large left ventricle end-diastolic size (>4.5 cm) and the presence of left atrium dilation.

CONCLUSION

CONCLUSION: In this study, echocardiographic parameters associated with TAF thromboembolic complications and TAF persistence after euthyroid state is achieved, were identified. This may be useful for the TAF adverse outcomes risk assessment tools development in the future.

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