rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2021-12-02rpcardio-2639Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯOmega-3 Polyunsaturated Fatty Acids: the Role in Prevention of Atrial Fibrillation in Patients with Coronary Artery Disease after Coronary Artery Bypass Graft SurgeryОмега-3 полиненасыщенные жирные кислоты: значение в профилактике фибрилляции предсердий у пациентов с ишемической болезнью сердца после проведения коронарного шунтированияhttps://orcid.org/0000-0001-9351-6177РубаненкоО. А.RubanenkoO. A.

Рубаненко Олеся Анатольевна.

Самара.

eLibrary SPIN 1546-2237

Olesya A. Rubanenko.

Samara.

eLibrary SPIN 1546-2237

olesya.rubanenko@gmail.comhttps://orcid.org/0000-0003-0387-8356ЩукинЮ. В.ShchukinYu. V.

Щукин Юрий Владимирович.

Самара.

eLibrary SPIN 1558-7591

Yuri V. Shchukin.

Samara.

eLibrary SPIN 1558-7591

https://orcid.org/0000-0003-4529-5896ЛимареваЛ. В.LimarevaL. V.

Лимарева Лариса Владимировна.

Самара.

SPIN  8741-4433

Larisa V. Limareva.

Samara.

eLibrary  SPIN  8741-4433

https://orcid.org/0000-0002-4581-8610РязановаТ. К.RyazanovaT. K.

Рязанова Татьяна Константиновна.

Самара.

eLibrary SPIN 1489-9183

Tatyana K. Ryazanova.

Samara.

eLibrary SPIN 1489-9183

https://orcid.org/0000-0002-3996-4689РубаненкоА. О.RubanenkoA. O.

Рубаненко Анатолий Олегович.

Самара.

eLibrary  SPIN  6947-1028

Anatolii O. Rubanenko.

Samara.

eLibrary  SPIN  6947-1028

https://orcid.org/0000-0002-4318-4247ДавыдкинИ. Л.DavydkinI. L.

Давыдкин Игорь Леонидович.

Самара.

eLibrary SPIN 1830-7497

Igor L. Davydkin.

Samara.

eLibrary SPIN 1830-7497

Самарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation2022130120221811219Copyright © Rubanenko O.A., Shchukin Y.V., Limareva L.V., Ryazanova T.K., Rubanenko A.O., Davydkin I.L., 20222022Рубаненко О.А., Щукин Ю.В., Лимарева Л.В., Рязанова Т.К., Рубаненко А.О., Давыдкин И.Л.Rubanenko O.A., Shchukin Y.V., Limareva L.V., Ryazanova T.K., Rubanenko A.O., Davydkin I.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2639Aim

Aim. To estimate the role of omega-3 polyunsaturated fatty acids (PUFAs) administration in atrial fibrillation (AF) prevention after planned coronary artery bypass graft (CABG) surgery.

Material and Methods

Material and Methods. Studied were 306 patients divided into two groups: patients of group I didn’t receive PUFAs (158 patients, 82.7% males) and patients of group II received PUFAs (148 patients, 89.3% males). PUFAs were prescribed in daily dose 2000 mg 5 days before surgery and in daily dose 1000 mg in postoperative period during 21 days.

Results

Results. Postoperative AF (POAF) occurred in 29.7% patients in group I and in 16.9% patients in group II (р=0.009). We found that after CABG in patients of the I group median IL-6 level was 39.3% higher (p=0.001), interleukin-10 – 20.2% higher (p=0.01), superoxide dismutase – 78.9% higher (р<0.001), malondialdehyde – 33.8% higher (p=0.03), docosahexaenoic acid – 31.8% lower (p=0.01) and omega-3 index – 43.4%    lower (p=0.04) than in patients of the II group.

According to multivariate regression analysis we found significant association between the factors of inflammation, oxidative stress and the risk POAF development.

Conclusions

Conclusions. In patients who took PUFAs, we found less activation of inflammation, oxidative stress, the increasing of docosahexaenoic acid and omega-3 index accompanied by the decreasing of POAF development rates up to 12.8%.

Цель

Цель. Изучить значение омега-3 полиненасыщенных жирных кислот (ПНЖК) в предотвращении развития фибрилляции предсердий (ФП) после плановой операции коронарного шунтирования (КШ).

Материал и методы

Материал и методы. Обследовали 306 пациентов, которых затем разделили на две группы: I группа не принимала омега-3 ПНЖК – (n=158; 82,7% мужчин), II группа принимала омега-3 ПНЖК (n=148; 89,3% мужчин). ПНЖК назначались в дозе 2000 мг/сут за 5 дней до КШ и в дозе 1000 мг/сут в послеоперационном периоде в течение 21 дня.

Результаты

Результаты. В процессе наблюдения послеоперационная ФП развилась у 29,7% пациентов I группы и у 16,9% больных II группы (р=0,009). После КШ в I группе уровень интерлейкина-6 был на 39,3% выше (р=0,001), интерлейкина-10 – на 20,2% выше (р=0,01), супероксиддисмутазы плазмы – на 78,9% выше (р<0,001), малонового диальдегида – на 33,8% выше (р=0,03), докозагексаеновой кислоты – на 55% ниже (р=0,01), омега-3 индекс – на 43,4% ниже (р=0,04) при сравнении со II группой. Многофакторный регрессионный анализ показал статистически значимую ассоциацию между показателями воспаления, окислительного стресса и риском развития послеоперационной ФП.

Заключение

Заключение. В группе терапии омега-3 ПНЖК после проведения КШ наблюдалась меньшая активация параметров воспаления и окислительного стресса на фоне повышения уровня докозагексаеновой кислоты и омега-3 индекса, что сопровождалось снижением частоты послеоперационной ФП на 12,8%.

фибрилляция предсердийкоронарное шунтированиеполиненасыщенные жирные кислотыокислительный стрессвоспалениеatrial fibrillationcoronary artery bypass graft surgerypolyunsaturated fatty acidsoxidative stressinflammationИсследование проведено при поддержке Самарского государственного медицинского университета.The study was performed with the support of the Samara State Medical University.ReferencesKorantzopoulos P, Letsas K, Fragakis N. et al. Oxidative Stress and Atrial Fibrillation: An Update. Free Radic Res. 2018;52(11-12):1199-209. DOI:10.1080/10715762.2018.1500696.Korantzopoulos P, Letsas K, Fragakis N. et al. Oxidative Stress and Atrial Fibrillation: An Update. Free Radic Res. 2018;52(11-12):1199-209. DOI:10.1080/10715762.2018.1500696.Conti VR. Preventing Postoperative Atrial Fibrillation: Is There One Best Option? Semin Thorac Cardiovasc Surg. 2018;30(1):14-15. DOI:10.1053/j.semtcvs.2018.02.015.Conti VR. Preventing Postoperative Atrial Fibrillation: Is There One Best Option? Semin Thorac Cardiovasc Surg. 2018;30(1):14-15. DOI:10.1053/j.semtcvs.2018.02.015.Oesterle A, Weber B, Tung R, et al. Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A Meta-analysis. Am J Med. 2018;131(7):795-804. DOI:10.1016/j.amjmed.2018.01.032.Oesterle A, Weber B, Tung R, et al. Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A Meta-analysis. Am J Med. 2018;131(7):795-804. DOI:10.1016/j.amjmed.2018.01.032.Nomani H, Mohammadpour AH, Moallem SM, et al. Anti-inflammatory Drugs in the Prevention of Post-Operative Atrial Fibrillation: A Literature Review. Inflammopharmacology. 2020;28 (1):111-29. DOI:10.1007/s10787-019-00653-x.Nomani H, Mohammadpour AH, Moallem SM, et al. Anti-inflammatory Drugs in the Prevention of Post-Operative Atrial Fibrillation: A Literature Review. Inflammopharmacology. 2020;28 (1):111-29. DOI:10.1007/s10787-019-00653-x.Wang H, Chen J, Zhao L. N-3 Polyunsaturated Fatty Acids for Prevention of Postoperative Atrial Fibrillation: Updated Meta-Analysis and Systematic Review. J Interv Card Electrophysiol. 2018;51(2):105-15 DOI:10.1007/s10840-018-0315-5.Wang H, Chen J, Zhao L. N-3 Polyunsaturated Fatty Acids for Prevention of Postoperative Atrial Fibrillation: Updated Meta-Analysis and Systematic Review. J Interv Card Electrophysiol. 2018;51(2):105-15 DOI:10.1007/s10840-018-0315-5.Wu JH, Marchioli R, Silletta MG, et al. Plasma phospholipid omega-3 fatty acids and incidence of postoperative atrial fibrillation in the OPERA trial. J Am Heart Assoc. 2013;2:e000397. DOI:10.1161/JAHA.113.000397.Wu JH, Marchioli R, Silletta MG, et al. Plasma phospholipid omega-3 fatty acids and incidence of postoperative atrial fibrillation in the OPERA trial. J Am Heart Assoc. 2013;2:e000397. DOI:10.1161/JAHA.113.000397.Gu J, Lundbye-Christensen S, Eschen RB, et al. Marine n-3 Fatty Acids Are Incorporated Into Atrial Tissue but Do Not Correlate With Postoperative Atrial Fibrillation in Cardiac Surgery. Vascul Pharmacol. 2016;87:70-5. DOI:10.1016/j.vph.2016.11.004.Gu J, Lundbye-Christensen S, Eschen RB, et al. Marine n-3 Fatty Acids Are Incorporated Into Atrial Tissue but Do Not Correlate With Postoperative Atrial Fibrillation in Cardiac Surgery. Vascul Pharmacol. 2016;87:70-5. DOI:10.1016/j.vph.2016.11.004.Tribulova N, Szeiffova Bacova B, Egan Benova T, et al. Omega-3 Index and Anti-Arrhythmic Potential of Omega-3 PUFAs. Nutrients. 2017;9(11):E1191. DOI:10.3390/nu9111191.Tribulova N, Szeiffova Bacova B, Egan Benova T, et al. Omega-3 Index and Anti-Arrhythmic Potential of Omega-3 PUFAs. Nutrients. 2017;9(11):E1191. DOI:10.3390/nu9111191.2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. DOI:10.1093/eurheartj/eht296.2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. DOI:10.1093/eurheartj/eht296.2014 ESC/EACTS Guidelines on Myocardial Revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed With the Special Contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541-619. DOI:10.1093/eurheartj/ehu278.2014 ESC/EACTS Guidelines on Myocardial Revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed With the Special Contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541-619. DOI:10.1093/eurheartj/ehu278.Рубаненко О.А., Фатенков О.В., Хохлунов С.М. с соавт. Влияние омега-3 полиненасыщенных жирных кислот на развитие фибрилляции предсердий после хирургической реваскуляризации миокарда. Клиническая Медицина. 2017;95(8):693-9. DOI:10.18821/0023-2149-2017-95-8-693-699.Rubanenko OA, Fatenkov OV, Khokhlunov SM, et al. The influence of omega-3 polyunsaturated fatty acids on atrial fibrillation development after surgical myocardial revascularisation. Klin Med. 2017; 95(8):693-9 (In Russ.) DOI:10.18821/0023-2149-2017-95-8-693-699.Рубаненко О.А., Фатенков О.В., Хохлунов С.М. с соавт. Комбинация омега-3 полиненасыщенных жирных кислот и статинов в профилактике фибрилляции предсердий после операции коронарного шунтирования. Клиническая медицина. 2017;95(9):817-23. DOI:10.18821/0023-2149-2017-95-9-817-823.Rubanenko OA, Fatenkov OV, Khokhlunov SM, et al. Combination of omega-3 polyunsaturated fatty acids and statins for the prevention of atrial fibrillation after coronary bypass surgery. Klin Med. 2017;95(9):817-23. (In Russ.) DOI:10.18821/0023-2149-2017-95-9-817-823.De Caterina R. N-3 fatty acids in cardiovascular disease. N Engl J Med. 2011;364(25):2439-50. DOI:10.1056/NEJMra1008153.De Caterina R. N-3 fatty acids in cardiovascular disease. N Engl J Med. 2011;364(25):2439-50. DOI:10.1056/NEJMra1008153.Billman GE. The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment. Pharmacol Ther. 2013;140(1):53-80. DOI:10.1016/j.pharmthera.2013.05.011.Billman GE. The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment. Pharmacol Ther. 2013;140(1):53-80. DOI:10.1016/j.pharmthera.2013.05.011.Darghosian L, Free M, Li J, et al. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Am J Cardiol. 2015;115(2):196-201. DOI:10.1016/j.amjcard.2014.10.022.Darghosian L, Free M, Li J, et al. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Am J Cardiol. 2015;115(2):196-201. DOI:10.1016/j.amjcard.2014.10.022.Stanger O, Aigner I, Schimetta W. et al. Antioxidant supplementation attenuates oxidative stress in patients undergoing coronary artery bypass graft surgery. Tohoku J Exp Med. 2014;232(2):145-54. DOI:10.1620/tjem.232.145.Stanger O, Aigner I, Schimetta W. et al. Antioxidant supplementation attenuates oxidative stress in patients undergoing coronary artery bypass graft surgery. Tohoku J Exp Med. 2014;232(2):145-54. DOI:10.1620/tjem.232.145.Bo L, Jiang S, Xie Y. Effect of Vitamin E and Omega-3 Fatty Acids on Protecting Ambient PM2.5-Induced Inflammatory Response and Oxidative Stress in Vascular Endothelial Cells. PLoS One. 2016;11(3):e0152216. DOI:10.1371/journal.pone.0152216.Bo L, Jiang S, Xie Y. Effect of Vitamin E and Omega-3 Fatty Acids on Protecting Ambient PM2.5-Induced Inflammatory Response and Oxidative Stress in Vascular Endothelial Cells. PLoS One. 2016;11(3):e0152216. DOI:10.1371/journal.pone.0152216.Zhang F, Yu H, Ni X, et al. Effect of ω-3 polyunsaturated fatty acids on the growth of IEC-6 cells injured by heavy metals. Biomed Rep. 2016;4(5):635-41. DOI:10.3892/br.2016.621.Zhang F, Yu H, Ni X, et al. Effect of ω-3 polyunsaturated fatty acids on the growth of IEC-6 cells injured by heavy metals. Biomed Rep. 2016;4(5):635-41. DOI:10.3892/br.2016.621.Ellulu MS, Khaza'ai H, Patimah I, et al. Effect of long chain omega-3 polyunsaturated fatty acids on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. Food Nutr Res. 2016;60:29268. DOI:10.3402/fnr.v60.29268.Ellulu MS, Khaza'ai H, Patimah I, et al. Effect of long chain omega-3 polyunsaturated fatty acids on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. Food Nutr Res. 2016;60:29268. DOI:10.3402/fnr.v60.29268.Alam SR, Stirrat C, Spath N, et al. Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. J Cardiothorac Surg. 2017;12(1):115. DOI:10.1186/s13019-017-0681-6.Alam SR, Stirrat C, Spath N, et al. Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery. J Cardiothorac Surg. 2017;12(1):115. DOI:10.1186/s13019-017-0681-6.Narducci ML, Pelargonio G, Rio T, et al. Predictors of postoperative atrial fibrillation in patients with coronary artery disease undergoing cardiopulmonary bypass: a possible role for myocardial ischemia and atrial inflammation. J Cardiothorac Vasc Anesth. 2014;28(3):512-9. DOI:10.1053/j.jvca. 2013.06.002.Narducci ML, Pelargonio G, Rio T, et al. Predictors of postoperative atrial fibrillation in patients with coronary artery disease undergoing cardiopulmonary bypass: a possible role for myocardial ischemia and atrial inflammation. J Cardiothorac Vasc Anesth. 2014;28(3):512-9. DOI:10.1053/j.jvca. 2013.06.002.Hoogeveen EK, Geleijnse JM, Kromhout D, et al. No effect of n-3 fatty acids supplementation on NT-proBNP after myocardial infarction: the Alpha Omega Trial. Eur J Prev Cardiol. 2015;22(5):648-55. DOI:10.1177/2047487314536694.Hoogeveen EK, Geleijnse JM, Kromhout D, et al. No effect of n-3 fatty acids supplementation on NT-proBNP after myocardial infarction: the Alpha Omega Trial. Eur J Prev Cardiol. 2015;22(5):648-55. DOI:10.1177/2047487314536694.Рубаненко О.А., Фатенков О.В., Хохлунов С.М., Лимарева Л.В. Роль супероксиддисмутазы в развитии послеоперационной фибрилляции предсердий у пациентов с ишемической болезнью сердца. Российский Кардиологический Журнал. 2017;22 (3):20-4. DOI:10.15829/1560-4071-2017-3-20-24Rubanenko OA, Fatenkov OV, Khokhlunov SM, Limareva LV. A role of superoxide dismutase in development of post-operation atrial fibrillation in coronary heart disease patients. Russian Journal of Cardiology. 2017;(3):20-4 (In Russ.) DOI:10.15829/1560-4071-2017-3-20-24Рубаненко О.А., Фатенков О.В., Хохлунов С.М., Лимарева Л.В. Значение факторов оксидативного стресса и антиоксидантной защиты в возникновении фибрилляции предсердий после хирургической реваскуляризации миокарда. Вестник Аритмологии. 2016;84:17-21.Rubanenko OA, Fatenkov OV, Khokhlunov SM, Limareva LV. Role of oxidative stress factors and antioxidant protection in development of atrial fibrillation after surgical myocardial revascularization. Vestnik Aritmologii. 2016;84:17-21 (In Russ.)Pasdois P, Parker JE, Griffiths EJ, et al. The role of oxidized cytochrome С in regulating mitochondrial reactive oxygen species production and its perturbation in ischaemia. Biochem J. 2011;436(2):493-505. DOI:10.1042/BJ20101957.Pasdois P, Parker JE, Griffiths EJ, et al. The role of oxidized cytochrome С in regulating mitochondrial reactive oxygen species production and its perturbation in ischaemia. Biochem J. 2011;436(2):493-505. DOI:10.1042/BJ20101957.Heshmati J, Morvaridzadeh M, Maroufizadeh S, et al. Omega-3 fatty acids supplementation and oxidative stress parameters: A systematic review and meta-analysis of clinical trials. Pharmacol Res. 2019;149:104462. DOI:10.1016/j.phrs.2019.104462.Heshmati J, Morvaridzadeh M, Maroufizadeh S, et al. Omega-3 fatty acids supplementation and oxidative stress parameters: A systematic review and meta-analysis of clinical trials. Pharmacol Res. 2019;149:104462. DOI:10.1016/j.phrs.2019.104462.Harris WS, Masson S, Barlera S, et al. Red blood cell oleic acid levels reflect olive oil intake while omega-3 levels reflect fish intake and the use of omega-3 acid ethyl esters: The Gruppo Italiano per lo Studio della Sopravvivenzanell‘Infarto Miocardico-Heart Failure trial. Nutr Res. 2016;36:989-94. DOI:10.1016/j.nutres.2016.06.012.Harris WS, Masson S, Barlera S, et al. Red blood cell oleic acid levels reflect olive oil intake while omega-3 levels reflect fish intake and the use of omega-3 acid ethyl esters: The Gruppo Italiano per lo Studio della Sopravvivenzanell‘Infarto Miocardico-Heart Failure trial. Nutr Res. 2016;36:989-94. DOI:10.1016/j.nutres.2016.06.012.Benedetto U, Angeloni E, Melina G, et al. N-3 Polyunsaturated fatty acids for the prevention of post-operative atrial fibrillation: a meta-analysis of randomized controlled trials. J Cardiovasc Med (Hagerstown). 2013;14:104-9. DOI:10.2459/JCM.0b013e32834a13c1.Benedetto U, Angeloni E, Melina G, et al. N-3 Polyunsaturated fatty acids for the prevention of post-operative atrial fibrillation: a meta-analysis of randomized controlled trials. J Cardiovasc Med (Hagerstown). 2013;14:104-9. DOI:10.2459/JCM.0b013e32834a13c1.Saravanan P, Bridgewater B, West AL, et al. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. Circ Arrhythm Electrophysiol. 2010;3(1):46-53. DOI:10.1161/CIRCEP. 109.899633.Saravanan P, Bridgewater B, West AL, et al. Omega-3 fatty acid supplementation does not reduce risk of atrial fibrillation after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial. Circ Arrhythm Electrophysiol. 2010;3(1):46-53. DOI:10.1161/CIRCEP. 109.899633.Рубаненко О.А., Рубаненко А.О., Щукин Ю.В., и др. Клинические, эхокардиографические показатели и маркеры окислительного стресса, ассоциированные с развитием фибрилляции предсердий у пациентов, подвергающихся операции коронарного шунтирования. Российский Кардиологический Журнал. 2020;25(7):3896. DOI:10.15829/1560-4071-2020-3896.Rubanenko OA, Rubanenko AO, Shchukin YuV, et al. Clinical, echocardiographic parameters and markers of oxidative stress associated with atrial fibrillation in patients undergoing coronary artery bypass graft surgery. Russian Journal of Cardiology. 2020;25(7):3896 (In Russ.) DOI:10.15829/1560-4071-2020-3896.

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