Hemodynamic and biochemical characteristics of patients with atrial fibrillation and anticoagulation of ≥65-year-old patients with atrial fibrillation in Estonia
Date
2023-11-24
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Abstract
Kodade virvendusarütmia (KVA) on sagedaseim rütmihäire maailmas, esinedes 2-4% täiskasvanud elanikest. Rütmihäire põhjustab patsiendi olulist elukvaliteedi häirumist ja suurendab kuni 5 korda ajuinsuldi riski. Teada on mitmeid selle rütmihäire riskifaktorid nagu hüpertensioon, diabeet ja uneapnoe aga ka ülekaal. Samas pole praeguseni selged selle rütmihäire kõik patofüsioloogilised ja hemodünaamikaga seotud mehhanismid. Kuna enamikel > 65 a patsientidel esineb kõrgenenud ajuinsuldi risk, siis trombi profülaktikaks on vajalik püsiv antikoagulantravi. Kui maailmas on uuringud näidanudantikoagulantravi alakasutust, siis Eesti kohta vastavad andmed puuduvad. Käesolevas doktoritöös uuriti nii KVA patsientide ja kontrollrühma vererõhu hemodünaamikaga seotud näitajaid, kui ka põletiku, oksüdatiivse stressi ja sidekoestumisega seotud biomarkereid . Selleks teostati rütmihäiretega patsientidel lisaks vereanalüüsidele vererõhu hemodünaamika määramine, et hinnata tsentraalse vererõhuga seotud muutusi ja arterite jäikust. Patsiente jälgiti 1 aasta jooksul rütmihäirete kordumise suhtes. Lisaks uurisime püsivat antikoagulantravi kasutamist üleriigiliselt ≥65 aastaste KVA patsientide seas hinnates ravimi kaetus väljakirutatud päevadoosidega. Leiti, et vaatamata sarnastele õlavarrelt mõõdetud vererõhkudele oli rütmihäirega patsientidel kõrgem tsentraalne vererõhk ja pulsilaine levikukiirus, mis viitab suuremale arterite jäikusele. Uuritavatel olid kõrgemad müeloperoksüdaasi, kõrgtundliku C-reaktiivse valgu, B-tüüpi natriureetilise propeptiidi N-fragmendi ja galektiin-3 väärtused. Kõrgenenud müeloperoksüdaas oli seotud KVA kordumise riskiga. Püsiv antikoagulantravi tarvitamine Eestis on äärmiselt madal ja ≥80% kaetus väljastatud antikoagulantravi retseptiga oli saavutatud vaid 57,4% 2019. aasta ja 44,5% 2020. aasta uuritavatest.
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, affecting 2-4% of the adult population. This arrhythmia significantly impairs the patient's quality of life and increases the risk of stroke by up to 5 times. Several risk factors for this arrhythmia are known, such as hypertension, diabetes, sleep apnea, and obesity. However, the complete pathophysiological and hemodynamic mechanisms related to this arrhythmia are not yet fully understood. Since a heightened risk of stroke is present in most patients ≥65 years old, continuous anticoagulant therapy is necessary for thrombus prevention. While studies globally have indicated underutilization of anticoagulant therapy, specific data for Estonia is lacking. In this doctoral thesis, both indicators related to the hemodynamics of blood pressure and biomarkers associated with inflammation, oxidative stress, and fibrosis were examined in AF patients and a control group. In addition to blood tests, hemodynamics of blood pressure were measured in patients with arrhythmias to assess changes related to central blood pressure and arterial stiffness. Patients were monitored for 1 year for recurrence of arrhythmias. Furthermore, the nationwide use of continuous anticoagulant therapy among AF patients aged ≥65 was investigated, evaluating medication coverage based on prescribed daily doses. It was found that despite similar blood pressure measurements taken from the arm, patients with arrhythmias had higher central blood pressure and pulse wave velocity, indicating greater arterial stiffness. Study participants exhibited higher levels of myeloperoxidase, high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and galectin-3. Elevated myeloperoxidase levels were associated with a higher risk of AF recurrence. The utilization of continuous anticoagulant therapy in Estonia is extremely low, with only 57.4% of the studied patients in 2019 and 44.5% in 2020 achieving ≥80% coverage based on issued anticoagulant therapy prescriptions.
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, affecting 2-4% of the adult population. This arrhythmia significantly impairs the patient's quality of life and increases the risk of stroke by up to 5 times. Several risk factors for this arrhythmia are known, such as hypertension, diabetes, sleep apnea, and obesity. However, the complete pathophysiological and hemodynamic mechanisms related to this arrhythmia are not yet fully understood. Since a heightened risk of stroke is present in most patients ≥65 years old, continuous anticoagulant therapy is necessary for thrombus prevention. While studies globally have indicated underutilization of anticoagulant therapy, specific data for Estonia is lacking. In this doctoral thesis, both indicators related to the hemodynamics of blood pressure and biomarkers associated with inflammation, oxidative stress, and fibrosis were examined in AF patients and a control group. In addition to blood tests, hemodynamics of blood pressure were measured in patients with arrhythmias to assess changes related to central blood pressure and arterial stiffness. Patients were monitored for 1 year for recurrence of arrhythmias. Furthermore, the nationwide use of continuous anticoagulant therapy among AF patients aged ≥65 was investigated, evaluating medication coverage based on prescribed daily doses. It was found that despite similar blood pressure measurements taken from the arm, patients with arrhythmias had higher central blood pressure and pulse wave velocity, indicating greater arterial stiffness. Study participants exhibited higher levels of myeloperoxidase, high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and galectin-3. Elevated myeloperoxidase levels were associated with a higher risk of AF recurrence. The utilization of continuous anticoagulant therapy in Estonia is extremely low, with only 57.4% of the studied patients in 2019 and 44.5% in 2020 achieving ≥80% coverage based on issued anticoagulant therapy prescriptions.
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Keywords
atrial arrhytmias, hemodynamics, arterial diseases, anticoagulants, biomarkers