Structural and functional changes of the heart and electrical disorders in patients with coronary artery disease with concomitant anemia
DOI:
https://doi.org/10.14739/2310-1210.2022.5.259063Keywords:
coronary artery disease, anemia, cardiac remodeling, autonomic dysfunction, ischemia, tachycardiaAbstract
The aim of the study: to investigate the effect of concomitant anemia on the features of cardiac remodeling and electrical disorders in patients with coronary artery disease (CAD).
Materials and methods. In total, 89 patients with CAD, stable angina II–III FC were examined (men – 34, women – 55, age – 69 (61; 72) years). All patients were divided into 2 groups: the main group (n = 44) consisted of patients with CAD and anemia, the comparison group (n = 45) – patients with CAD without iron-deficiency anemia. The results of echocardioscopy and 24-hour ECG (Holter) monitoring were analyzed.
Results. Left ventricular (LV) end-diastolic and end-systolic volume were higher in the main group by 24.7 % (U = 60.0; P < 0.05) and 25.9 % (U = 53.5, P < 0.05), respectively; end-diastolic and end-systolic left ventricular index also were higher in the main group by 20.2 % (U = 99.5; P < 0.05) and 34.8 % (U = 98.5; P < 0.05), respectively. There was no statistically significant difference in the types of LV geometry; however, the left ventricular mass index was significantly higher by 12.0 % in patients of the main group (U = 315.5; P < 0.05). The patients of both groups mostly showed diastolic dysfunction type 1, however, in the main group, there was a tendency to increase the number of patients with diastolic dysfunction type 2 and type 3. In patients of the main group, in the active period, there was a decrease in SDNNi by 31.85 % (U = 216; P < 0.05), VLF by 53.79 % (U = 176; P < 0.05); increase in LF by 60.56 % (U = 53; P < 0.05) and SI by 2.14 times (U = 43.5; P < 0.05). The presence of anemia in patients with CAD caused a twofold increase in the risk of autonomic dysfunction (BP = 2.045; 95 % CI 1.084–3.861; P < 0.05), 1.5 times increase in tachycardia episodes (BP = 1.510; 95 % CI 1.047–2.178; P < 0.05) and 2.2 times increase in myocardial ischemia (BP = 2.173; 95 % CI 1.047–4.512; P < 0.05).
Conclusions. Concomitant anemia in patients with coronary artery disease adversely affects the structural and geometric properties of the heart, leads to an overall suppression of heart rate variability, increases the sympathetic tone of the autonomic nervous system in daytime period and the stress index, as well as raises the risk of autonomic dysfunction, tachycardia and myocardial ischemia.
References
Moroz, H. Z., Hidzynska, I. M. & Lasytsia, T. S. (2021). Kompleksna otsinka komorbidnosti v klinichnii praktytsi: metodychni pidkhody ta praktychne vykorystannia [Comprehensive assessment of comorbidity in clinical practice: methodical approaches and practical use]. Klinichna ta profilaktychna medytsyna, (2), 32-38. [in Ukrainian]. https://doi.org/10.31612/2616-4868.2(16).2021.04
Zemedikun, D. T., Gray, L. J., Khunti, K., Davies, M. J., & Dhalwani, N. N. (2018). Patterns of Multimorbidity in Middle-Aged and Older Adults: An Analysis of the UK Biobank Data. Mayo Clinic proceedings, 93(7), 857-866. https://doi.org/10.1016/j.mayocp.2018.02.012
Kendir, C., van den Akker, M., Vos, R., & Metsemakers, J. (2018). Cardiovascular disease patients have increased risk for comorbidity: A cross-sectional study in the Netherlands. The European journal of general practice, 24(1), 45-50. https://doi.org/10.1080/13814788.2017.1398318
Khyts, A. R. (2019). Ishemichna khvoroba sertsia: diahnostyka ta likuvannia [Ischemic heart disease: diagnosis and treatment]. Ukrainskyi medychnyi chasopys. [in Ukrainian]. https://www.umj.com.ua/article/163681/ishemichna-hvoroba-sertsya-diagnostika-ta-likuvannya
World Health Organization. (2020). WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. World Health Organization. License: CC BY-NC-SA 3.0 IGO. https://apps.who.int/iris/handle/10665/331505
Serik, S. A., & Tkachenko, O. V. (2020). Tiazhka forma anemii v patsiientky z ishemichnoiu khvoroboiu sertsia: klinichnyi vypadok [A severe form of anemia in a patient with coronary heart disease: a clinical case]. Ratsionalna farmakoterapiia, (3-4), 8-12. [in Ukrainian].
Kravchun, P. H., & Ryndina, N. H. (2018). Syndrom kardiorenalnoi anemii [Cardiorenal anemia syndrome]. Kharkiv: FOP Mezina V.V. [in Ukrainian].
Koval, O. A. (2020). Diahnostyka ta korektsiia zalizodefitsytnykh staniv u patsiientiv iz sertsevo-sudynnymy zakhvoriuvanniamy [Diagnosis and correction of iron deficiency conditions in patients with cardiovascular diseases]. Zdorovia Ukrainy, (4), 44-45. [in Ukrainian].
Rodionova, I. O., & Hubska, O. Yu. (2019). Zahalni ta okremi pytannia anemichnoho syndromu v klinichnii praktytsi likaria-interna [General and specific issues of anemic syndrome in the clinical practice of an intern doctor]. Kyiv, NMU imeni O.O. Bohomoltsia. [in Ukrainian].
Ivanov, V. P., Kolesnyk, M. O., Kolesnyk, O. M., & Ivanova, Ye. I. (2018). Anemii v rakursi problemy khronichnoi sertsevoi nedostatnosti: patogenez i laboratorna diagnostyka [Anemia from the perspective of the problem of chronic heart failure: pathogenesis and laboratory diagnosis]. Acta medica Leopoliensia, (2), 69-76. [in Ukrainian]. https://doi.org/10.25040/aml2018.02.069
Bogdanova N. O., Pogorela N. H., Lukyanetz E. A. (2021). Rol hipoksii u rozvytku deiakykh patolohichnykh staniv ta zloiakisnykh pukhlyn [The role of hypoxia in the development of some pathological conditions and malignant tumors]. Fiziolohichnyi zhurnal, 67(2), 53-66. [in Ukrainian].
Stepanova, N. M., Kolesnyk, M. O., & Novakivskyi, V. V. (2019). Dozozalezhnyi vplyv tryvaloho aktyvatora retseptoriv erytropoetynu na vehetatyvnu rehuliatsiiu sertsevoi diialnosti ta kardiovaskuliarni podii u khvorykh, yaki likuiutsia metodom hemodiafiltratsii [Dose-dependent effect of long-term erythropoietin receptor activator on autonomic regulation of cardiac activity and cardiovascular events in patients treated with hemodiafiltration]. Zaporozhye medical journal, 21(3), 346-354. [in Ukrainian]. https://doi.org/10.14739/2310-1210.2019.3.169112
Hamed, S. A., Elhadad, A. F., Abdel-aal, R. F., & Hamed, E. A. (2020). Cardiac Autonomic Function with Iron Deficiency Anemia. Journal of Neurology and Experimental Neuroscience, 6(2), 51-57. https://doi.org/10.17756/jnen.2020-075
Lisun, Yu. B., & Uhlev, Ye. I. (2020). Variabelnist sertsevoho rytmu, vykorystannia ta metody analizu [Heart rate variability, applying and methods of analysis]. Pain, anaesthesia & intensive care, (4), 83-89. https://doi.org/10.25284/2519-2078.4(93).2020.220693
Yamada, S., Yoshihisa, A., Kaneshiro, T., Amami, K., Hijioka, N., Oikawa, M., & Takeishi, Y. (2020). The relationship between red cell distribution width and cardiac autonomic function in heart failure. Journal of arrhythmia, 36(6), 1076-1082. https://doi.org/10.1002/joa3.12442
Syvolap, V. D., Zemlianyi, Ya. V., & Nazarenko, O. V. (2016). Elektrychna aktyvnist miokarda za danymy dobovoho monitoruvannia EKH u khvorykh na sertsevu nedostatnist zi zberezhenoiu fraktsiieiu vykydu ta bezsymptomnoiu diastolichnoiu dysfunktsiieiu [Myocardial electrical activity according to daily ECG monitoring in patients with heart failure with preserved ejection fraction and asymptomatic diastolic dysfunction]. Zaporozhye medical journal, (1), 4-7. [in Ukrainian]. https://doi.org/10.14739/2310-1210.2016.1.64160
Alnuwaysir, R., Hoes, M. F., van Veldhuisen, D. J., van der Meer, P., & Beverborg, N. G. (2021). Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. Journal of clinical medicine, 11(1), 125. https://doi.org/10.3390/jcm11010125
Núñez, J., Miñana, G., Cardells, I., Palau, P., Llàcer, P., Fácila, L., Almenar, L., López-Lereu, M. P., Monmeneu, J. V., Amiguet, M., González, J., Serrano, A., Montagud, V., López-Vilella, R., Valero, E., García-Blas, S., Bodí, V., de la Espriella-Juan, R., Lupón, J., Navarro, J., … Myocardial‐IRON Investigators. (2020). Noninvasive Imaging Estimation of Myocardial Iron Repletion Following Administration of Intravenous Iron: The Myocardial-IRON Trial. Journal of the American Heart Association, 9(4), e014254. https://doi.org/10.1161/JAHA.119.014254
Sutil-Vega, M., Rizzo, M., & Martínez-Rubio, A. (2019). Anemia and iron deficiency in heart failure: a review of echocardiographic features. Echocardiography, 36(3), 585-594. https://doi.org/10.1111/echo.14271
Schwartz, A. J., Converso-Baran, K., Michele, D. E., & Shah, Y. M. (2019). A genetic mouse model of severe iron deficiency anemia reveals tissue-specific transcriptional stress responses and cardiac remodeling. The Journal of biological chemistry, 294(41), 14991-15002. https://doi.org/10.1074/jbc.RA119.009578
Rineau, E., Gaillard, T., Gueguen, N., Procaccio, V., Henrion, D., Prunier, F., & Lasocki, S. (2018). Iron deficiency without anemia is responsible for decreased left ventricular function and reduced mitochondrial complex I activity in a mouse model. International journal of cardiology, 266, 206-212. https://doi.org/10.1016/j.ijcard.2018.02.021
Haddad, S., Wang, Y., Galy, B., Korf-Klingebiel, M., Hirsch, V., Baru, A. M., Rostami, F., Reboll, M. R., Heineke, J., Flögel, U., Groos, S., Renner, A., Toischer, K., Zimmermann, F., Engeli, S., Jordan, J., Bauersachs, J., Hentze, M. W., Wollert, K. C., & Kempf, T. (2017). Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure. European heart journal, 38(5), 362-372. https://doi.org/10.1093/eurheartj/ehw333
Burns, J. A., Sanchez, C., Beussink, L., Daruwalla, V., Freed, B. H., Selvaraj, S., & Shah, S. J. (2018). Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction. The American journal of cardiology, 122(8), 1359-1365. https://doi.org/10.1016/j.amjcard.2018.06.045
Lopresti, A. L. (2020). Association between Micronutrients and Heart Rate Variability: A Review of Human Studies. Advances in nutrition, 11(3), 559-575. https://doi.org/10.1093/advances/nmz136
Jibhkate, A., & Lath, R. (2019). Assessing severity of involvement of autonomic functions in iron-deficiency anemia patients. National Journal of Physiology, Pharmacy and Pharmacology, 9(5), 429-433. https://doi.org/10.5455/njppp.2019.9.0307912032019
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