Rational Pharmacotherapy in Cardiology

Advanced search

Features of Structural and Functional Changes in the Heart in Elderly Patients with Coronary Heart Disease and Atrial Fibrillation

Full Text:


Supraventricular arrhythmias, including atrial fibrillation (AF), are a current problem for patients in the older age group due to the possibility of lifethreatening complications. Elderly patients have pre-conditions for the development of supraventricular rhythm disturbances (age-related structural and functional changes in the myocardium, concomitant diseases).

Aim. To study the features of structural and functional changes in the myocardium of the left heart in elderly patients, depending on the presence of supraventricular arrhythmias.

Material and methods. The cross-sectional study included 200 individuals aged 60 to 89 years. All participants underwent echocardiographic examination and 24-hour electrocardiogram (ECG) monitoring. The patients of the study cohort were divided into 3 groups: group 1 consisted of patients with coronary heart disease (CHD) without heart rhythm disturbances (n=80); group 2 consisted of patients with CHD and paroxysmal AF (n=40); group 3 consisted of patients with CHD and supraventricular extrasystoles (n=40). The control group consisted of patients of the older age group without CHD and rhythm disturbances (n=40).

Results. In patients with paroxysmal AF and frequent supraventricular extrasystoles, large sizes of the left atrium were revealed (anteroposterior dimension: 4.30±0.07 and 4.12±0.12 cm; upper-lower: 6.15±0.03 and 5.96±0.10 cm; medial-lateral: 4.15±0.11 and 3.87±0.09 cm, respectively). In patients with CHD and rhythm disturbances, the presence of a combined increase in the size of the left atrium and a decrease in myocardial contractility was revealed (ejection fraction of the left atrium in groups 2 and 3 – 27.2±0.1% and 27.9±0.1%, respectively, vs 36.3±0.1% and 38.20±0.02%, respectively in group 1 and control). The duration of ischemic changes during 24-hour ECG monitoring was also greater in group 3 compared with groups 1 and 2 (249.6 vs 27.1 and 66.4 min, respectively). In groups 2 and 3, a discordant effect of the sympathetic and parasympathetic nervous systems on heart rate variability was revealed.

Conclusion. For elderly patients, morphological and functional changes are characteristic, which consist in the restructuring of the myocardium and changes in heart rate variability with a prevalence of the sympathetic part of the autonomic nervous system.

About the Authors

L. I. Folomeeva
City Clinical Hospital №31 (Moscow)
Russian Federation

Larisa I. Folomeeva – MD, Cardiologist

Lobachevskogo ul. 42, Moscow, 119415

E. V. Filippov
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Eugene V. Filippov – MD, PhD, Associate Professor, Chair of Outpatient Therapy and Preventive Medicine

Vysokovoltnaya ul. 9, Ryazan, 390026


1. Chugh S.S., Havmoeller R., Narayanan K., et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47. DOI:10.1161/CIRCULATIONAHA.113.005119.

2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37(38):2893-962. DOI:10.1093/eurheartj/ehw210.

3. Revishvili A.Sh., Rzaev F.G., Gorev M.V., et al. Diagnosis and treatment of atrial fibrillation: clinical recommendations [cited by Jul 04, 2019]. Available from: (In Russ.)

4. Mlynarska A., Mlynarsky R., Golba K.S. Older age and a higher EHRA score allow higher levels of frailty syndrome to be predicted in patients with atrial fibrillation. Aging Male. 2017;20(1):23-7. DOI:10.1080/13685538.2016.1241761.

5. Medvedev N.V., Gorshunova N.K. Age-associated sarcopenia as a risk factor for the development of myocardial dysfunction and chronic heart failure in elderly patients with arterial hypertension. Advances in Gerontology. 2012;25(3):456-60 (In Russ.)

6. Forouzanfar M.H., Alexander L., Anderson H.R., et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287-323. DOI:10.1016/S0140-6736(15)00128-2.

7. Mills K.T., Bundy J.D., Kelly T.N., et al. Global disparities of hypertension prevalence and control: asystematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441-50. DOI:10.1161/CIRCULATIONAHA.115.018912.

8. Cleland J.G., Pellicori P., Dierckx R. Clinical trials in patients withheart failure and preserved left ventricular ejection fraction. Heart Fail Clin. 2014;10:511-23. DOI:10.1016/j.hfc.2014.04.011.

9. Kotecha D., Lam C.S.P., Van Veldhuisen D.J., et al. Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Vicious Twins. J Am Coll Cardiol. 2016;68(20):2217-28. DOI:10.1016/j.jacc.2016.08.048.

10. Vermond R.A., Geelhoed B., Verweij N., et al. Incidence of atrial fibrillation and relationship with cardiovascular events, heart failure, and mortality: a community-based study from the Netherlands. J Am Coll Cardiol. 2015;66:1000-7. DOI:10.1016/j.jacc.2015.06.1314.

11. O'Neal W.T., Sandesara P., Patel N., et al. Echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging. 2017;18(7):725- 9. DOI:10.1093/ehjci/jex038.

12. 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;37:2893-962. DOI:10.1093/eurheartj/ehw210.

13. Freedman B., Camm J., Calkins H., et al. Screening for atrial fibrillation: areport of the AF-SCREEN International Collaboration. Circulation. 2017;135:1851-67. DOI:10.1161/CIRCULATIONAHA.116.026693.

14. Ermoshkin V.I. Causes of cardiovascular disease. New hypotheses. Moscow: Nobel Press; 2013 (In Russ.)

15. Kac Ja.A., Parhonjuk E.V., Korsunova E.N., et al. Chronic sclerotic disease. Modern Problems of Science and Education 2015;1:1 [cited by Jul 04, 2019]. Available from: (In Russ.)

For citation:

Folomeeva L.I., Filippov E.V. Features of Structural and Functional Changes in the Heart in Elderly Patients with Coronary Heart Disease and Atrial Fibrillation. Rational Pharmacotherapy in Cardiology. 2020;16(4):536-541. (In Russ.)

Views: 63

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)