emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.2.1615emcardio-83Research ArticleОригинальные научные публикацииOriginal Scientific ResearchФакторы риска развития неблагоприятных сердечно-сосудистых событий у пациентов с сочетанием некомпактной и дилатационной кардиомиопатииRisk factors for the development of adverse cardiovascular events in patients with a combination of non-compaction and dilated cardiomyopathyКомиссароваС. М.KomissarovaS.

220036, ул. Розы Люксембург, д. 110Б, Минск

220036, R. Luxemburg 110, Minsk

РинейскаяН. М.RineiskaN.

220036, ул. Розы Люксембург, д. 110Б, Минск

220036, R. Luxemburg 110, Minsk

СеврукТ. В.SevrukT.

220036, ул. Розы Люксембург, д. 110Б, Минск

220036, R. Luxemburg 110, Minsk

ЕфимоваА. А.EfimovaA.

220036, ул. Розы Люксембург, д. 110Б, Минск

220036, R. Luxemburg 110, Minsk

ГУ «Республиканский научно-практический центр «Кардиология»State Institution Republican Scientific and Practical Centre of Cardiology2022230620256216151624Copyright © Комиссарова С.М., Ринейская Н.М., Севрук Т.В., Ефимова А.А., 20252025Комиссарова С.М., Ринейская Н.М., Севрук Т.В., Ефимова А.А.Komissarova S., Rineiska N., Sevruk T., Efimova A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/83

Цель – выявить факторы, ассоциированные с неблагоприятными сердечно-сосудистыми событиями в когорте пациентов с сочетанием некомпактной (НКМП) и дилатационной кардиомиопатии (ДКМП) для идентификации пациентов высокого риска.Материалы и методы. Обследовано 104 пациентов с сочетанием НКМП и ДКМП в возрасте от 31 до 52 лет (медиана возраста 41 года; мужчин – 81; женщин – 23), которым помимо традиционных клинических методов ис- следования, выполняли магнитно-резонансную томографию (МРТ) сердца с отсроченным контрастированием гадолинием. Конечные точки исследо- вания включали прогрессирование хронической сердечной недостаточности (ХСН) до III функционального класса (ФК) NYHA, требующее госпитализации, желудочковые тахиаритмии и эмболические события.Результаты. За период наблюдения 24 (от 7 до 183) месяца зарегистрированы неблагоприятные сердечно-сосудистые события у 84 (80,7%) пациентов, из них прогрессирование ХСН до ФК III NYHA – у 47 (45,2%). Однофакторный анализ показал, что независимыми факторами риска прогрессирования ХСН являлись следующие характеристики: симптомы ХСН II ФК при исходном обследовании (ОР 15,4; 95% ДИ 1,9-125,3, p = 0,0002), мужской пол (ОР 4,6; 95% ДИ 1,3-16,1, p = 0,01), фракция выброса левого желудочка (ФВ ЛЖ) < 40% (ОР 1,3; 95% ДИ 1,1-1,4, p = 0,0004), увеличение индекса конечно-диастолического объёма (иКДО) (ОР 1,02; 95% ДИ 1,01-1,04, p = 0,0262), увеличение индекса конечно-систолического объёма (иКСО) (ОР 1,04; 95 % ДИ 1,01-1,06, p = 0,0080), фракция изменения площади правого желудочка (ФИП ПЖ) (ОР 0,9; 95 % ДИ 0,8-1,0, p = 0,0478) по данным трансторакальной эхокардиографии (ТТЭ), снижение уровня глобальной продольной деформации (GLS) ≤ 11% (ОР 4,7; 95 % ДИ 1,2-17,4, p = 0,0207) по данным 2D Strain и масса фиброза миокарда по данным МРТ сердца с отсроченным контрастированием (ОР 0,94; 95% ДИ 0,9-1,0, p = 0,0329).У 26 (25,0 %) пациентов развились желудочковые тахиаритмии, факторами риска которых были: наличие желудочковой экстрасистолии (ЖЭС) > 500 уд/мин (ОР 45; 95% ДИ 7,5-751,2, p = 0,0005) при суточном мониторировании (СМ) ЭКГ, снижение уровня GLS ≤ 11% (ОР 5,3; 95% ДИ 1,03-27,4, p = 0,0282) по данным 2D Strain.У 11 (10,6%) развились эмболические события, предикторами которых были: фибрилляция/трепетание предсердий (ОР 24; 95 % ДИ 3,0-188,2, p = 0,0037), индекс объёма левого предсердия (иОЛП) (ОР 32,2; 95 % ДИ 1,2-956, p = 0,0352) и ФВ ЛЖ < 40% по данным МРТ сердца (ОР 1,33; 95 % ДИ 1,03-1,7, p = 0,0269).Заключение. Факторами, ассоциированными с риском развития неблагоприятных событий являются наличие при исходном обследовании симптомов ФК СН II NYHA, мужской пол, ФВ ЛЖ ≤ 40 %, увеличение иОЛП ≥ 57 мл/м2, снижение GLS ≤ 11%, наличие фиброза миокарда по данным МРТ сердца, ЖЭС > 500 уд/мин по данным СМ ЭКГ, которые могут быть применены для идентификации пациентов с высоким риском развития неблагоприятных событий.

The objective is to identify factors associated with adverse cardiovascular events in a cohort of patients with a combination of non-compaction (NCCM) and dilated cardiomyopathy (DCM) in order to reveal high-risk patients.Materials and methods. 104 patients with a combination of NCCM and DCM aged 31 to 52 years (median age 41 years; 81 men; 23 women) were examined, who, in addition to traditional clinical research methods, underwent cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement. The endpoints of the study included progression of chronic heart failure (CHF) to functional class (FC) III NYHA requiring hospitalization, ventricular tachyarrhythmias and thromboembolic events.Results. During the 24-month follow-up period (from 7 to 183) adverse cardiovascular events were registered in 84 (80.7%) patients, of which progression of CHF to FC III NYHA – in 47 (45.2%). Univariate analysis showed that the following characteristics were independent risk factors for the progression of CHF: symptoms of CHF II FC at the initial examination (HR 15.4; 95% CI 1.9-125.3, p = 0.0002), male gender (HR 4.6; 95% CI 1.3-16.1, p = 0.01), LVEF < 40% (HR 1.3; 95% CI 1.1-1.4, p = 0.0004), an increase in left ventricular end-diastolic volume index (LV EDVI) (HR 1.02; 95% CI 1.01-1.04, p = 0.0262), an increase in left ventricular end-systolic volume index (LV ESVI) (HR 1.04; 95% CI 1.01-1.06, p = 0.0080), right ventricular fractional area change (RV FAC) (HR 0.9; 95% CI 0.8-1.0, p = 0.0478) according to transthoracic echocardiogram (TTE) data, a decrease in global longitudinal strain (GLS) level ≤ 11% (HR 4.7; 95% CI 1.2-17.4, p = 0.0207) according to 2D Strain and percentage of myocardial fibrosis according to CMR imaging with late gadolinium enhancement (HR 0.94; 95% CI 0.9-1.0, p = 0.0329).26 (25.0%) patients developed ventricular tachyarrhythmias, associated with the following risk factors: premature ventricular contractions (PVCs) > 500 bpm (HR 45; 95% CI 7.5-751.2, p = 0.0005), a decrease in the GLS level ≤ 11% (HR 5.3; 95% CI 1.03-27.4, p = 0.0282) according to 2D Strain data.11 (10.6%) developed embolic events, the predictors of which were: atrial fibrillation/flutter (HR 24; 95% CI 3.0-188.2, p = 0.0037), left atrium volume index (LAVI) (HR 32.2; 95% CI 1.2-956, p = 0.0352) and LVEF < 40% according to CMR (HR 1.33; 95% CI 1.03-1.7, p = 0.0269).Conclusion. Factors associated with the risk of adverse events are the pre- sence at the initial examination of symptoms of FC II CH by NYHA, male gender, LVEF ≤ 40%, an increase in LAVI ≥ 57 ml/m2, a decrease in GLS ≤ 11%, the presence of myocardial fibrosis according to CMR imaging with late gadolinium enhancement, PVCs > 500 bpm according to 24-hour ECG monitoring, which can be used to identify patients at high risk of adverse cardiovascular events.

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