RISK FACTORS OF ARRHYTHMIAS IN PATIENTS WITH ACUTE DECOMPENSATION OF CHRONIC HEART FAILURE

The aim of the research. The aim of this study was to investigate risk factors of arrhythmias, the frequency of acute kidney injury (AKI) in patients with acute decompensation of chronic heart failure (ADCHF) and AKI impact on dynamics of electrocardiographic parameters. Materials and methods.103 patients with acute decompensation of chronic heart failure who were survival on 10 hospital day were studied. Twenty-four-hour ECG recordings were performed on 1 and 10 days of hospitalization using automatic algorithm to measure QT and heart rate for analyze the arrhythmogenic factors. AKI was diagnosed according to KDIGO Guidelines (2012). Results. AKI was revealed in 25 (24,3%) patients with ADCHF. At admitted to the hospital the corrected interval QT (QTc) > 440 ms had 42(41%) patients with ADCHF. Stabilization of the state is characterized by shortening of the QTc interval. In men, AKI had impact on the QTc: 475,50±31,72 ms vs. 445,16±29,67 ms without AKI (р=0,02). This effect persists until discharge from hospital. In women, the effect of AKI on the QTc prolongation was not detected. Patients with AKI had more premature ventricular complexes: 622,0 (128,0; 1488,0) premature ventricular complexes vs. 389.0 (42,0; 1237,0) premature ventricular complexes in patients without AKI on admission (p=0,005 ), 501,0 (81,0; 1150,0) premature ventricular complexes in patients with AKI vs. 325,0 (70,0; 1228,0) without AKI (p <0,001) on the 10th day of treatment. In sinus rhythm revealed an increase of the index of variability of QT and pathological significance of heart rate turbulence. The values of heart rate variability, exceeding the “risk-sharing point of death” did not improve on 10 day treatment. Conclusion. At admitted to the hospital QTc prolongation was found in 42 (41%) patients with ADCHF. In men, the presence of AKI was associated with the QTc prolongation. Although there is clinical stabilization in patients with acute decompensated of chronic heart failure on 10 day treatment arrhythmogenic factors are saved.

1. Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П., и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная недостаточность. 2013; 7(81): 379-472. Mareev V.Ju., Ageev F.T., Arutjunov G.P., et al. National guidelines of OSSN, RSC and RNMOT for the diagnosis and treatment of chronic heart failure (fourth revision). Russian Heart Failure Journal. 2013; 7(81): 389-472 [in Russian].

2. Ponikowski A., Stefan D., Héctor Bueno A., 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC), Developed with the special contribution of the Heart Failure Association (HFA) of the ESC, European Heart Journal.2016; 37: 2129–2200.

3. Bock J.S., Gottlieb S.S. Cardiorenal Syndrome: New Perspectives. Circulation. 2010; 121: 2592-2600.

4. De Luca L., Fonarow G.C., Adams K.F. Jr et al. Acute heart failure syndromes: clinical scenarios and pathophysiologic targets for therapy. Heart Fail Rev. 2007; 12(2): 97–104.

5. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120(4): c179-84. doi: 10.1159/000339789.

6. Mehta R.L., Kellum J.A., Shah S.V. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2): R31.

7. Ronco C., Haapio M., House A., et al. Cardiorenal syndrome. J. Am. Coll. Cardiol. 2008; 52: 1527–1539.

8. Zhou Q, Zhao C, Xie D, et al. Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: impact on outcomes. BMC Nephrol. 2012 Jul 2; 13:51. doi: 10.1186/1471-2369-13-51.

9. Shirakabe A, Hata N, Kobayashi N, et al. Prognostic impact of acute kidney injury in patients with acute decompensated heart failure. Circ J. 2013; 77(3): 687-696. doi:10.1253/circj.cj-12-0994.

10. Мензоров М.В., Шутов А.М. , Макеева Е.Р., и др. Острое повреждение почек у больных с острой декомпенсацией хронической сердечной недостаточности. Клиницист. 2013; 2: 29-33. DOI:10.17650/1818-8338-2013-2-29-33. Menzorov M.V., Shutov A.M. , Makeeva E.R., et al. Acute kidney injury in patients with acute decompensation of chronic heart failure. The Clinician 2013; 2: 29-33. DOI:10.17650/1818-8338-2013-2-29-33 [in Russian].

11. Haigney M.C., Zareba W., Gentlesk P.J. Multicenter Automatic Defibrillator Implantation Trial II investigators QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial [MADIT] II. Journal of the American College of Cardiology. 2004; 44: 1481–1487.

12. Piccirillo G., Magrì D., Matera S. QT variability strongly predicts sudden cardiac death in asymptomatic subjects with mild or moderate left ventricular systolic dysfunction: a prospective study. European Heart Journal. 2007; 28: 1344–1350.

13. Silvia G., Blomström-Lundqvist С., Borggrefe M., ESC 2015 Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). European Heart Journal. 2015; 36: 2793–2867.

14. Berger R.D., Kasper E.K., Baughman K.L. Beat-to-beat QT interval variability. Novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy. Circulation.1997; 6: 1557-1565.

15. Straus S.M., Kors J.A., De Bruin M.L. et al Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 2006; 47: 362–367.

16. Chugh S.S., Reinier K., Singh T. Determinants of Prolonged QT Interval and Their Contribution to Sudden Death Risk in Coronary Artery Disease The Oregon Sudden Unexpected Death Study. Circulation 2009; 119: 663–670.

17. Гимаев Р.Х., Рузов В.И., Разин В.А. Нарушение электрофизиологических свойств миокарда у больных артериальной гиперто- нией и сахарным диабетом 2-го типа. Клиническая медицина. 2012; 90(2): 35-39. Gimaev R.Kh., Ruzov V.I., Razin V.A. Disturbance of electrophysiological properties of the myocardium in patients with arterial hypertension and type 2 diabetes mellitus. Klinicheskaya meditsina. 2012; 90 (2): 35-39 [in Russian].

18. Рузов В.И., Гимаев Р.Х., Разин В.А., и др. Структурно-функциональное состояние миокарда и показатели сигнал-усредненной электрокардиограммы у больных гипертонической болезнью. Кардиоваскулярная терапия и профилактика. 2005; 4(6-2): 21-26. Ruzov V.I., Gimaev R.Kh., Razin V.A., et al. Structural and functional state of the myocardium and indicators signal-averaged electrocardiogram in patients with hypertension. Kardiovaskulyarnaya terapiya i profilaktika. 2005; 4(6-2): 21-26 [in Russian].

19. Tereshchenko L.G., Cygankiewicz I., McNitt S. Predictive value of beatto-beat QT variability index across the continuum of left ventricular dysfunction: competing risks of noncardiac or cardiovascular death and sudden or nonsudden cardiac death. Circulation: Arrhythmia and Electrophysiology.2012; 5: 719–727.

20. Moore R.K., Groves D.G., Barlow P.E. Heart rate turbulence and death due to cardiac decompensation in patients with chronic heart failure. European Journal of Heart Failure. 2006; 8: 585–590.

21. Cygankiewicz I., Zareba W., Vazquez R. Heart rate turbulence predicts all-cause mortality and sudden death in congestive heart failure patients. Heart Rhythm. 2008; 5: 1095–1102.