ФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙ И АРТЕРИАЛЬНАЯ ГИПЕРТОНИЯ: ГЕНДЕРНЫЕ ОСОБЕННОСТИ ЖЕЛУДОЧКОВО-ПРЕДСЕРДНОГО РЕМОДЕЛИРОВАНИЯ ПРИ СОХРАНЕННОЙ ФРАКЦИИ ВЫБРОСА ЛЕВОГО ЖЕЛУДОЧКА

На сегодняшний день имеется достаточное количество данных, подтверждающих существование гендерных особенностей эпидемиологии, патогенеза и прогностического значения фибрилляции предсердий (ФП). Структурная и функциональная перестройка левого предсердия, являющаяся главным субстратом возникновения и поддержания ФП, может быть более выражена у женщин, причиной чему, вероятно, являются свойственные им особенности нарушения диастолической функции миокарда левого желудочка, ремоделирование которого нахо- дится в тесной связи с параметрами давления в аорте. Гендерные различия центрального контура пульсовой волны были обнаружены во многих исследованиях, однако прогностическое значение этих параметров, а также их связь с ремоделированием левого предсердия нуждаются в дополнительном изучении. Текущие рекомендации по ведению больных с ФП уравнивают стратегии контроля ритма и частоты сокращений желудочков. В исследовании RACE выяснилось, что если среди мужчин исходы при обеих стратегиях не отличались, то у женщин рандомизация в группу контроля ритма достоверно повышала риск наступления комбинированной конечной точки, включившей сердечно-сосудистую смерть, развитие хронической сердечной недостаточности, тромбоэмболические осложнения, тяжелые побочные эффекты антиаритмической терапии. По-видимому, в определенных ситуациях у женщин с рецидивирующей ФП стратегию контроля частоты желудочковых сокращений можно рассматривать даже как более предпочтительную. Существующую терапию ФП сложно назвать оптимальной, в связи с чем одним из путей ее усовершенствования может быть учет гендерных особенностей предсердно-желудочково-артериального взаимодействия. Для подтверждения этого предположения необходимо проведение крупных хорошо организованных проспективных исследований.

фибрилляция предсердий, ремоделирование левого предсердия, диастолическая дисфункция, центральное давление

1. Kirchhof P., Benussi S., Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962.

2. Kannel W., Wolf P., Benjamin E. et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population based estimates. Am J Cardiol. 1998; 82(8A):2N-9N.

3. Go A.,Hylek E., Phillips K. et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370-5.

4. Sulimov V.A., Golitsyn S.P., Panchenko E.P. et al.Diagnostics and treatment of atrialfibrillation. RSC, RSSA and RACVS guidelines. Rossiyskiy Kardiologicheskiy Zhurnal. 2013;4(suppl.3):1-100. (In Russ.) [Сулимов В.А., ГолицынС.П.,Панченко Е.П.,и соавт. Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА и АССХ). Российский Кардиологический Журнал. 2013;4(прил.3):1-100].

5. Manolis A., Rosei E., Coca A. et al. Hypertension and atrial fibrillation: diagnostic approach, prevention and treatment. Position paper ofthe Working Group ‘HypertensionArrhythmias and Thrombosis’ ofthe European Society of Hypertension. J Hypertens. 2012;30(2):239-52.

6. Simone G. de, Palmieri V. Diastolic dysfunction in arterial hypertension. J Clin Hypertens. 2001;3(1): 22-7.

7. Matsuda M., Matsuda Y. Mechanism ofleft atrial enlargementrelated to ventricular diastolic impairment in hypertension. Clin Cardiol 1996;19(12):954-9.

8. Sanchis L., Gabrielli L., Andrea R. et al. Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2015;16(1):62-7.

9. EUGenMed Cardiovascular Clinical Study Group, Regitz-Zagrosek V., Oertelt-Prigione S. et al. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J. 2016;37(1):24-34.

10. Anand S., Islam S., Rosengren A. et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J. 2008;29(7):932-40.

11. Appelros P., Stegmayr B., TerОnt A. A review on sex differences in stroke treatment and outcome. Acta Neurol Scand. 2009;121(6):359-69.

12. Bosch R., Pittrow D., Beltzer A. et al. Gender differences in patients with atrial fibrillation. Herzschrittmachertherapie + Elektrophysiologie. 2013;24(3):176-83.

13. Rienstra M., van VeldhuisenD.,Hagens V. et al. Gender-related differences in rhythm controltreatment in persistent atrial fibrillation: data of the Rate Control Versus Electrical Cardioversion (RACE) study. J Am Coll Cardiol. 2005;46(7):1298-306.

14. Dagres N., Nieuwlaat R., Vardas P.E. et al. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the EuroHeart Survey on Atrial Fibrillation. J Am Coll Cardiol. 2007;49(5):572-7.

15. Camm A., Accetta G., Al Mahmeed W. et al. Impact of gender on eventrates at 1 year in patients with newly diagnosed non-valvular atrialfibrillation: contemporary perspective from the GARFIELD-AF registry. BMJ Open. 2017;7(3):e014579.

16. Ball J., Carrington M., Wood K. et al. Women versus men with chronic atrial fibrillation: insights from the StandardversusAtrial FibrillationspEcificmanagemenT studY(SAFETY). PLoSOne.2013;8(5):e65795.

17. Lee D., Gona P., Vasan R. et al. Relation of disease pathogenesis and risk factors to heart failure with preserved orreduced ejection fraction: insights from the Framingham Heart Study ofthe NationalHeart, Lung, and Blood Institute. Circulation. 2009;119(24):3070-77.

18. Borlaug B., Redfield M. Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation. 2011;123(18):2006-14.

19. ScantleburyD., Borlaug B.Why are women more likely than men to develop heartfailure with preserved ejection fraction? Curr Opin Cardiol. 2011;26(6):562-8.

20. Wyse D., Van Gelder I., Ellinor P. et al. Lone atrial fibrillation: does it exist? J Am CollCardiol. 2014;63(17):1715-23.

21. Gardin J., McClelland R., KitzmanD. et al. M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol. 2001;87(9):1051-7.

22. Beinart R., Boyko V., Schwammenthal E. et al. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol. 2004;44(2):327-34.

23. Bouzas-Mosquera A., Broullón F.J., Álvarez-García N. et al. Left atrial size and risk for all-cause mortality and ischemic stroke. CMAJ. 2011;183(10):E657-64.

24. Pellicori P., Zhang J., Lukaschuk E. et al. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J. 2015;36(12):733-742.

25. Melenovsky V., Hwang S., Redfield M. et al. Left atrialremodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Hear Fail. 2015;8(2):295-303.

26. Proietti M., Raparelli V., Basili S. et al. Relation of female sex to left atrial diameter and cardiovascular death in atrial fibrillation: The AFFIRM Trial. Int J Cardiol. 2016;207:258-63.

27. YuH., Lee J.,Kim T. et al.Advanced left atrialremodeling and appendage contractile dysfunction inwomen than in men among the patients with atrial fibrillation: potential mechanism of stroke. J Am Heart Assoc. 2016;5(7):e003361.

28. Kou S., Caballero L., Dulgheru R. et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Hear J Cardiovasc Imaging. 2014;15(6):680-90.

29. Li Z., Wang Z., Yin Z. et al. Gender differences in fibrosis remodeling in patients with long-standing persistent atrial fibrillation. Oncotarget. 2017 [Epub ahead of print].

30. De Jong A., Van Gelder I., Vreeswijk-Baudoin I. et al. Atrial remodeling is directly related to end-diastolic left ventricular pressure in a mouse model of ventricular pressure overload. PLoS One. 2013;8(9):e72651.

31. Yamano M., Yamano T., Iwamura Y. et al. Impact of left ventricular diastolic property on left atrialfunction from simultaneous left atrial and ventricularthree-dimensional echocardiographic volume measurement. Am J Cardiol. 2017;119(10):1687-93.

32. Lee J., Shim C., WiJ. et al. Left ventricular diastolic function is closely associated with mechanical function of the left atrium in patients with paroxysmal atrial fibrillation. Circ J. 2013;77(3):697-704.

33. Kim T., Shim C., Park J. et al. Left ventricular diastolic dysfunction is associated with atrial remodeling and risk or presence of stroke in patients with paroxysmal atrial fibrillation. J Cardiol. 2016;68(2): 104-9.

34. Kloch-Badelek M., Kuznetsova T., Sakiewicz W., et al. Prevalence of left ventricular diastolic dysfunction in European populations based on cross-validated diagnostic thresholds. Cardiovasc Ultrasound. 2012;10(1):10.

35. Fujimoto N., Okada Y., Shibata S. et al. Effects of sex and hypertension subtype on haemodynamics and left ventricular diastolic function in older patients with stage 1 hypertension. J Hypertens. 2013;31(11):2282-9.

36. LevyD., Larson M.,Vasan R. et al. The progression from hypertension to congestive heartfailure.JAMA. 1996;275(20):1557-62.

37. Aurigemma G., Silver K., McLaughlin M. et al. Impact of chamber geometry and gender on left ventricular systolic function in patients > 60 years of age with aortic stenosis. Am J Cardiol. 1994;74(8): 794-8.

38. Gori M., Lam C., Gupta D. et al. Sex-specific cardiovascular structure and function in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16(5):535-42.

39. Pruijm M., Vollenweider P., Mooser V. et al. Inflammatory markers and blood pressure: sex differences and the effect of fat mass in the CoLaus Study. J Hum Hypertens. 2013;27(3):169-75.

40. Gillis E., Sullivan J. Sex Differences in Hypertension: Recent Advances. Hypertension. 2016;68(6): 1322-7.

41. Meyer S., van der Meer P., van Deursen V.M. et al. Neurohormonal and clinical sex differences in heart failure. Eur Heart J. 2013;34(32):2538-47.

42. Hart E., Charkoudian N., Wallin B. et al. Sex and ageing differences in resting arterial pressure regulation: the role of the β-adrenergic receptors. J Physiol. 2011;589(Pt 21):5285-97.

43. Kararigas G., Dworatzek E., Petrov G. et al. Sex-dependent regulation of fibrosis and inflammation in human left ventricular remodelling under pressure overload. Eur J Heart Fail. 2014;16(11):1160-7.

44. Okura H., Takada Y., Yamabe A. et al. Age- and gender-specific changes in the left ventricular relaxation: a Doppler echocardiographic study in healthy individuals. Circ Cardiovasc Imaging. 2009;2(1): 41-6.

45. McEnieryC.,CockcroftJ.,RomanM. et al.Central blood pressure: current evidence and clinical importance. Eur Heart J. 2014;35(26):1719-25.

46. Vlachopoulos C., Aznaouridis K., O’Rourke M.F. et al. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J. 2010;31(15):1865-71.

47. Chirinos J., Kips J.,JacobsD. et al.Arterial wave reflections and incident cardiovascular events and heart failure: MESA (Multiethnic Study of Atherosclerosis). J Am Coll Cardiol. 2012;60(21):2170-7.

48. Chirinos J., Zambrano J., Chakko S. et al. Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease. Hypertension. 2005;45(5):980-5.

49. Hashimoto J., Westerhof B., Westerhof N. et al. Different role of wave reflection magnitude and timing on left ventricular mass reduction during antihypertensive treatment. J Hypertens. 2008;26(5): 1017-24.

50. Chirinos J., Segers P., Duprez D. et al. Late systolic central hypertension as a predictor of incident heart failure: the Multi-ethnic Study of Atherosclerosis. J Am Heart Assoc. 2015;4(3):e001335.

51. Chirinos J., Segers P., Gillebert T. et al Arterial properties as determinants of time-varying myocardial stress in humans. Hypertension. 2012;60(1):64-70.

52. Mitchell G., Lacourciere Y.,Arnold J. et al. Changes in aortic stiffness and augmentation index after acute converting enzyme or vasopeptidase inhibition. Hypertension. 2005;46(5):1111-7.

53. Mitchell G., Parise H., Benjamin E. et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension. 2004;43(6): 1239-45.

54. Segers P., Rietzschel E., De Buyzere M. et al. Noninvasive (input) impedance, pulse wave velocity, and wave reflection in healthy middle-aged men and women. Hypertension. 2007;49(6):1248-55.

55. London G., Guerin A., Pannier B. et al. Influence of sex on arterial hemodynamics and blood pressure. Role of body height. Hypertension. 1995;26(3):514-9.

56. Shim C., Park S., Choi D. et al. Sex differences in central hemodynamics and their relationship to left ventricular diastolic function. J Am Coll Cardiol. 2011;57(10):1226-33.

57. Russo C., Jin Z., Palmieri V. et al. Arterial stiffness and wave reflection: sex differences and relationship with left ventricular diastolic function. Hypertension. 2012;60(2):362-8.

58. Redfield M., Jacobsen S., Borlaug B. et al. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005;112(15):2254-62.

59. JannerJ., Godtfredsen N., Ladelund S. et al. Aortic augmentation index:reference values in a large unselected population by means of the SphygmoCor device. Am J Hypertens. 2010;23(2):180-5.

60. Higashi H., Okayama H., Saito M. et al. Relationship between augmentation index and left ventricular diastolic function in healthy women and men. Am J Hypertens. 2013;26(11):1280-6.

61. JannerJ., Godtfredsen N., Ladelund S. et al.High aortic augmentation index predicts mortality and cardiovascular events in men from a general population, but not in women. Eur J Prev Cardiol. 2013;20(6):1005-12.

62. Williams B., Lacy P., Thom S. et al. for the CAFE and ASCOT investigators. Differential impact of blood pressure loowering drugs on central aortic pressure and clinical outcomes. Circulation. 2006;113: 1213-25

63. Dahlof B., Devereux R., Kjeldsen S. et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpointreduction in hypertension study (LIFE) a randomised trial against atenolol. Lancet. 2002;59:995-1003.

64. Bangalore S., Sawhney S., Messerli F. Relation of beta-blocker-induced heart rate lowering and cardioprotection in hypertension. J Am Coll Cardiol. 2008;52:1482-9.

65. Wachtell K., Lehto M., Gerdts E. et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol. J Am Coll Cardiol. 2005;45(5):712-9.

66. Gerdts E., Wachtell K., Omvik P. et al. Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpointreduction in hypertension trial.Hypertension. 2007;49(2):311-6.

67. Sardana M., Syed A., Hashmath Z. et al. Beta-blocker use is associated with impaired left atrial function in hypertension. J Am Heart Assoc. 2017;6(2):e005163.

68. CaseyD., Curry T.,Joyner M. et al.Acute β-adrenergic blockade increases aorticwave reflection in young men and women: differing mechanisms between sexes. Hypertension. 2012;59(1):145-50.

69. Hoshida S., Shinoda Y., Ikeoka K. et al. Age- and sex-related differences in diastolic function and cardiac dimensions in a hypertensive population. ESC Heart Fail. 2016;3(4):270-7.

70. Orlova Y.A., Mikhailov G.V., Vitsenya M.V. Comparative effect of bisoprolol and verapamil on central and radial blood pressure in patients with arterial hypertension. Serdtse. 2017;16 (1):59-65. (In Russ.) [Орлова Я.А., Михайлов Г.В., Виценя М.В. Сравнительное влияние бисопролола и верапамила на центральное и периферическое АД у больных артериальной гипертензией). Сердце. 2017;16 (1):59-65].

71. Ulimoen S.R., Enger S., Pripp A.H. et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J. 2014;35(8):517-24.

72. Raatikainen M. Is verapamil a double-edged sword in rate control of paroxysmal atrial fibrillation? Hear Rhythm. 2010;7(5):584-5.

73. Kolloch R., Legler U., Champion A. et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease:findings from the INternationalVErapamil-SR/trandolaprilSTudy (INVEST). Eur Heart J. 2008;29:1327-34.

74. Steinberg B., Kim S., Thomas L. et al. Increased heartrate is associated with higher mortality in patients with atrialfibrillation (AF):results from the Outcomes Registry for BetterInformed Treatment ofAF (ORBIT‐AF). J Am Heart Assoc. 2015;4(9):e002031.

75. Böhm M., Schumacher H., Linz D. et al. Low resting heart rates are associated with new-onset atrial fibrillation in patients with vascular disease:results of the ONTARGET/TRANSCEND studies. JInternMed. 2015;278(3):303-12.

76. Aladin A., Al Rifai M., Rasool S. et al. Relation of resting heart rate to incident atrial fibrillation (from the Henry Ford Hospital Exercise Testing Project). Am J Cardiol. 2017;119(2):262-7.