Extrasystolic arrhythmia: is it an additional risk factor of atherosclerosis?

Science and Innovations in Medicine

Shchukin

2022

Aim to determine the relationship between extrasystoles (ES) and the development of arterial thromboembolic complications. Material and methods. The study included 440 patients with ES 700 or more per 24 hours, control group 88 people with ES less than 700. All patients underwent laboratory and instrumental examinations: lipid spectrum, hemostasis indicators; 24-hours ECG monitoring; echocardiography (EchoCG); Doppler ultrasound and digital sphygmography (SG) of the main arteries; ultrasound of the aorta branches, renal arteries. According to the indications, the patients were administered: stress EchoCG with physical exercises, coronary angiography, pancerebral angiography, renal arteries angiography, computed tomography, magnetic resonance imaging of the brain. All patients of the main group were divided into 2 subgroups, depending on the moment of occurrence of ES ventricular systole in the cardiocycle, regardless of the ectopic center: subgroup A (120) patients with ES before the peak of transmitral blood flow; subgroup B (320) after the peak of the transmitral blood flow. Patients were observed during 1 year and the development of arterial thromboembolic events was analyzed. Results. According to the main clinical, laboratory and instrumental data, patients of subgroups A, B and the control group were equivalent. Also, during 1 year follow-up, a significantly higher development of arterial thromboembolic events was observed in subgroup A. When comparing the linear blood flow velocity and volumetric blood flow, there was a significant increase in parameters during the spreading of the first post-extrasystolic contraction wave. A similar trend was observed in the parameters of the kinetics of the arterial vascular wall (velocity, acceleration, power, work). Conclusion. Extrasystoles are an additional risk factor for arterial thromboembolic events. The main danger is not the ES itself, but the wave of the first post-extrasystolic contraction, which can become the starting point for the instability of atherosclerotic plaques, leading to tears, parietal thrombosis, and embolism along the arterial vessel.

Section: Discussionunclassified

Section: Introductionunclassified

Extrasystoles: relationship with arterial thromboembolic complications

Science and Innovations in Medicine

Shchukin

2022

“…Group 1 Group 2 Control group that also is observed in other arrhythmias, for example, in first post-extrasystolic wave after the compensatory pause of extrasystole, in atrioventricular blockades, the first regular wave after sinus rhythm restoration after AF or heart palpitation, in activation of the pacemaker after prolonged asystole as well as in the other situations when the pulse wave with increased hemodynamic characteristics spreads after the long pause between ventricular contractions. We described these effects in our previous publications [38,39]. And in this case the main importance will play not only the quantity of such situations but also more the characteristics of these pulse waves.…”

Section: Stroke and Tia In 1-year Investigationmentioning

confidence: 94%

Cryptogenic stroke in atrial fibrillation without intra-heart thrombi: possible mechanisms

Galati

et al. 2022

vmirvz

Background. Up to 45% of ischemic strokes are cryprogenic.Aim is to study which variant of permanent AF without intra-heart thrombi is the most unfavorable in appearing of stroke.Methods. We observed 202 patients with permanent AF without intra-heart thrombi and hemodynamically not significant carotid bifurcation atherosclerotic stenosis. We performed echocardiography, 24-hours monitoring of electrocardiography (ECG), ultrasound of brachiocephalic arteries, sphygmography of common carotid arteries, computer tomography of the brain, hemostasiograms, lipid profile, hemoglobin A1c. According to the 24-hours ECG monitoring data, we divided patients into two groups up to the maximum pauses between ventricular complexes in AF: patients with a pause <1,5 seconds (113); ≥1,5 seconds (89). Both groups were on the same standard therapy including novel oral anticoagulants. We observed the patients during 1 year to analyze the verified stroke or transient ischemic attack (TIA).Results. In ultrasound, there was an increase of linear blood flow velocity in the area of carotid stenosis during the spread of the pulse wave after the long pause between ventricular contractions in group 2 up to 2,5 m/sec as in hemodynamically significant stenosis. In 1-year observation, there was the higher stroke in group 2.Conclusion. The appearance of stroke and TIA in AF is higher in patients who have 1,5 seconds and more of maximum duration pauses between ventricular contractions. The reason of cryptogenic stroke can be the atherosclerotic plaque defragmentation with further embolism, caused by additional mechanical impact of increased hemodynamical parameters of pulse wave after long pause between ventricular contractions.

Extrasystoles: adverse effects of the first postextrasystolic contraction

Shchukin

et al. 2021

jour

Aim. To determine the changes of parameters of heart biomechanics and kinetics of arteries, to reveal the adverse events of first post-extrasystolic contraction.Materials and methods. In our investigation we included 286 patients. We excluded all the main traditional risk factors of the atherosclerosis. All the patients were branched into two main groups in accordance to the quantity of extrasystoles per 24 hours: I group – less than 3000, II group – more than 3000 extrasystoles per 24 hours. We took the data about complaints, anamnesis, made laboratory and instrumental investigations to reveal the character and severity of atherosclerotic process.Results. We determined that the atherosclerotic process was more advanced and more often in the group II. Also the atherosclerosis was more severe in patients with extrasystoles in the phase of cardiocycle before opening of the mitral valve and before the transmitral blood flow peak. The parameters (acceleration, speed, power, work) that were calculated by apexcardiography and sphygmography increased with the further tendency: if earlier extrasystole appears in cardiocycle, than more changes were observed.Conclusion. The first post-extrasystolic contraction causes the increase of all parameters of heart biomechanics and kinetics of vessels and can be an additional factor of progressing of atherosclerosis.