Статья
Роль ожирения в развитии фибрилляции предсердий: современное состояние проблемы
Фибрилляция предсердий (ФП) — одно из наиболее распространенных нарушений сердечного ритма. Возникновение ФП ухудшает качество жизни пациентов, и увеличивает риск развития фатальных кардиоваскулярных осложнений. Ожирение является мировой эпидемией, распространенность которой увеличилась вдвое за прошедшие 30 лет. В настоящее время обсуждается роль ожирения как одного из предрасполагающих факторов возникновения ФП. В современной литературе описаны несколько механизмов влияния избыточнои массы тела на развитие аритмии: активация симпато-адреналовой нервной системы, повышение активности ренин-ангиотензин-альдостероновой системы, появление артериальной гипертензии, инсулинорезистентность, нарушение липидного обмена. Несмотря на большое количество проведенных исследований в этой области, патогенез появления и прогрессирования ФП при ожирении до конца не изучен. К молекулярным механизмам появления ФП у тучных пациентов относят возникновение системного воспаления. Наиболее значимая воспалительная активность наблюдается в эпикардиальной жировой ткани. Доказано негативное влияние провоспалительных цитокинов и дисфункции адипоцитов на развитие ФП. Оценка клинического статуса больного и знание тонких механизмов аритмогенеза у тучных пациентов позволяет обсуждать специфические подходы к лечению, что согласуется с современными представлениями о персонализированной медицине.
1. Krijthe BP, Kunst A, Benjamin EJ, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34:2746-51. doi:101093/eurheartj/eht280.
2. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation — developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14(10):1385-413. doi:10.1093/europace/eus305.
3. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-81. doi:10.1016/S0140-6736(14)60460-8.
4. Schnabel RB, Yin X, Gona P, et al. 50-year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386:154-62. doi:10.1016/S0140-6736(14)61774-8.
5. Wong CX, Sullivan T, Sun MT, et al. Obesity and the risk of incident, post-operative, and post-ablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies. JACC Clinical Electrophysiology. 2015;1:139-52. doi:10.1016/j.jacep.2015.04.004.
6. Goudis CA, Korantzopoulos P, Ntalas IV, et al. Obesity and atrial fibrillation: A comprehensive review of the pathophysiological mechanisms and links. J Cardiol. 2015;66(5):361-9. doi:10.1016/j.jjcc.2015.04.002.
7. Kotsis V, Stabouli S, Papakatsika S, et al. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010;33(5):386-93. doi:10.1038/hr.2010.9.
8. Ogunsua AA, Shaikh AY, Ahmed M, McManus DD. Atrial Fibrillation and Hypertension: Mechanistic, Epidemiologic, and Treatment Parallels. Methodist Debakey Cardiovasc J. 2015;11(4):228-34.
9. Yang T, Yang P, Roden DM, et al. Novel KCNA5 mutation implicates tyrosine kinase sig naling in human atrial fibrillation. Heart Rhythm. 2010;7(9):1246-52.
10. Lumeng CN, DelProposto JB, Westcott DJ, et al. Phenotypic switching of adipose tissue macrophages with obesity is generated by spatiotemporal differences in macrophage subtypes. Diabetes. 2008;57(12):3239-46. doi:10.2337/db08-0872.
11. Fantuzzi G. Health versus disease asthecatalyst for biomedical research: the science of adipokinesas a caseinpoint. Front Endocrinol. 2014;5(136):1-3. doi:10.3389/fendo.2014.00136.
12. Goudis C, Korantzopoulos P, Ntalas I. Diabetes mellitus and atrial fibrillation: Pathophysiological mechanisms and potential up stream therapies. International J Cardiology. 2015;184:617-22. doi:10.1016/j.ijcard.2015.03.052.
13. Yagmur J, Yetkin O, Cansel M. Assessment of atrial electromechanical delay and influential factors in patients with obstructive leepapnea. Sleep Breath. 2012;16(1):83-8. doi:10.1007/s11325-010-0477-6.
14. Khawaja O, Bartz T, Ix JH, et al. Plasma free fattyacids and risk of atrial fibrillation (from the Cardiovascular Health Study). Am J Cardiol. 2012;110(2):212-6. doi:10.1016/j.amjcard.2012.03.010.
15. Gizurarson S, Stahlman M, Omerovic E, et al. Atria lfibrillation in patients admitted to coronary careunit in western Sweden — focus on obesity and lipotoxicity. J Electrocardiol. 2015;48(5):853-60. doi:10.1016/j.jelectrocard.2014.12.010.
16. Mazurek T, Kiliszek M, Kobylecka M, et al. Relation of proinflammatory activity of epicardial adipose tissue to the occurrence of atrial fibrillation. Am J Cardiol. 2014;113(9):1505-8. doi:10.1016/j.amjcard.2014.02.005.
17. Nagashima K, Okumura Y, Watanabe I, et al. Does location of epicardial adipose tissue correspond to endocardial high dominant frequency or complex fractionated atrial electrogram sites during atrial fibrillation? Circ Arrhythm Electrophysiol. 2012;5(4):676-83. doi:10.1161/CIRCEP.112.971200.
18. Mahajan R, Lau DH, Brooks AG, et al. Electrophysiological, electro anatomical and structural remodeling of the atria as a consequence of sustained obesity. JACC. 2015;66(1):1-11. doi:10.1016/j.jacc.2015.04.058.
19. Fox CS, Gona P, Hoffmann U, et al. Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham Heart Study. Circulation. 2009;119(12):1586-91. doi:10.1161/CIRCULATIONAHA.108.828970.
20. Драпкина О. М., Николаева М. В. Патогенетические механизмы развития фибрилляции предсердий при ожирении. Рациональная фармакотерапия в кардиологии. 2016;12(5):582-9. doi:10.20996/1819-6446-2016-12-5-582-589.
21. Salgado-Somoza A, Teijeira-Fernandez E, Fernandez AL, et al. Proteomic analysis of epicardial and subcutaneous adipose tissue reveals differences in proteins involved in oxidative stress. Am J Physiol Heart Circ Physiol. 2010;299(1):H202-9. doi:10.1152/ajpheart.00120.2010.
22. Chen PS, Chen LS, Fishbein MC, et al. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res. 2014;114(9):1500-15. doi:10.1161/CIRCRESAHA.114.303772.
23. Aviles RJ, Martin DO, Apperson-Hansen C, et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003; 108(24):3006-10. doi: 101161/01.CIR.0000103131.70301.4F.
24. Lin H, Sinner MF, Brody JA, et al. Targeted sequencing in candidate genes for atrial fibrillation: the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Targeted Sequencing Study. Heart Rhythm. 2014;11(3):452-7 doi:10.1016/j.hrthm.2013.11.012.
25. Gaudino M, Andreotti F, Zamparelli R, et al. The -174G/C interleukin6 polymorphism influences postoperative interleukin6 levels and postoperative atrial fibrillation. Is atrial fibrillation an inflammatory complication? Circulation. 2003 ;108 Suppl1:II195-9. doi:10.1161/01.cir.0000087441.48566.0d.
26. Kondo H, Abe I, Gotoh K, et al. Interleukin 10 Treatment Ameliorates High-Fat Diet-Induced Inflammatory Atrial Remodeling and Fibrillation. Circ Arrhythm Electrophysiol. 2018;11(5):e006040. doi:10.1161/CIRCEP.117.006040.
27. Girerd N, Pibarot P, Fournier D, et al. Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery. Eur Heart J. 2009;30(10):1270-8. doi:10.1093/eurheartj/ehp091.
28. Marott SC, Nordestgaard BG, Zacho J, et al. Does elevated Creactive protein increase atrial fibrillation risk? A Mendelian randomization of 47,000 individuals from the general population. JACCl. 2010;56(10):789-95. doi:10.1016/j.jacc.2010.02.066.
29. Choi EK, Chang PC, Lee YS, et al. Triggered firing and atrial fibrillation in transgenic mice with selective atrial fibrosis induced by overexpression of TGF-01. Circ J. 2012;76(6):1354-62. PMCID: PMC3593311.
30. Hu YF, Chen YJ, Lin YJ, et al. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015;12(4):230-43. doi:101038/nrcardio.2015.2.
31. Li SB, Yang F, Jing L, et al. Myeloperoxidase and risk of recurrence of atrial fibrillation after catheter ablation. J Investig Med. 2013;61(4):722-7. doi:10.2310/JIM.0b013e3182857fa0.
32. Richter B, Gwechenberger M, Socas A, et al. Markers of oxidative stress after ablation of atrial fibrillation are associated with inflammation, delivered radiofrequency energy and early recurrence of atrial fibrillation. Clin Res Cardiol. 2012; 101 (3):217-25. doi:10.1007/s00392-011-0383-3.
33. Hoogstra-Berends F, Meijering RA, Zhang D, et al. Heat shock proteininducing compounds as therapeutics to restore proteostasis in atrial fibrillation. Trends Cardiovasc Med. 2012;22(3):62-8. doi:101016/j.tcm.2012.06.013.
34. Hu YF, Yeh HI, Tsao HM, et al. Electrophysiological correlation and prognostic impact of heat shock protein 27 in atrial fibrillation. Circ Arrhythm Electrophysiol. 2012;5(2):334-40. doi:10.1161/CIRCEP.111.965996.
35. Brundel BJ, Shiroshita-Takeshita A, Qi X, et al. Induction of heat shock response protects the heart against atrial fibrillation. Circ Res. 2006;99(12):1394-402. doi:10.1161/01.RES.0000252323.83137.fe.
36. Chang SL, Chen YC, Hsu CP, et al. Heat shock protein inducer modifies arrhythmogenic substrate and inhibits atrial fibrillation in the failing heart. Int J Cardiol. 2013;168(4):4019-26. doi:10.1016/j.ijcard.2013.06.072.
37. Lau DH, Shipp NJ, Kelly DJ, et al. Atrial arrhythmia in ageing spontaneously hypertensive rats: unraveling the substrate in hypertension and ageing. PLoS One. 2013;8(8):e72416. doi:10.1371/journal.pone.0072416.
38. Kramer F. Galectin-3: clinical utility and prognostic value in patients with heart failure. Research Reports in Clinical. Cardiology. 2013;4:13-12. doi:10.2147/RRCC.S28562.
39. Chen D, Procter N, Goh V, et al. New onset atrial fibrillation is associated with elevated galectin-3 levels. Int J Cardiol. 2016;223:48-9. doi: 10.1016/j.ijcard.2016.08.172.
40. Clementy N, Benhenda N, Piver E, et al. Serum Galectin-3 Levels Predict Recurrences after Ablation of Atrial Fibrillation. Sci Rep. 2016;6:34357. doi:10.1038/srep34357.
41. Scridon A, Dobreanu D, Chevalier P, et al. Inflammation, a link between obesity and atrial fibrillation.Inflamm Res. 2015;64(6):383-93. doi:10.1007/s00011-015-0827-8.
42. Ybarra J, Resmini E, Planas F, et al. Relationship between adiponectin and left atrium size in uncomplicated obese patients: adiponectin, a link between fat and heart. Obes Surg. 2009;19(9):1324-32. doi:10.1007/s11695-009-9924-5.
43. Macheret F, Bartz TM, Djousse L, et al. Higher Circulating Adiponectin Levels Are Associated with Increased Risk of Atrial Fibrillation in Older Adults. Heart. 2015;101(17):1368-74. doi:10.1136/heartjnl-2014-307015.
44. Ermakov S, Azarbal F, Stefanick ML, et al. The associations of leptin, adiponectin and resistin with incident atrial fibrillation in women. Heart. 2016;102(17):1354-62. doi:10.1136/heartjnl-2015-308927.
45. Shimano M, Shibata R, Tsuji Y, et al. Circulating Adiponectin Levels in Patients With Atrial Fibrillation. Circ J. 2008;72(7):1120-4. doi:10.1253/circj.72.1120.
46. Carnevale R, Pastori D, Peruzzi M, et al. Total adiponectin is inversely associated with platelet activation and CHA2DS2-VASc score in anticoagulated patients with atrial fibrillation. Mediators Inflamm. 2014;2014:908901. doi:10.1155/2014/908901.
47. Akoumianakis I, Akawi N, Antoniades C. Exploring the Crosstalk between Adipose Tissue and the Cardiovascular System. Korean Circ J. 2017;47(5):670-85. doi:10.4070/kcj.2017.0041.
48. Kazama K, Okada M, Yamawaki H. A novel adipocytokine, omentin, inhibits monocrotaline-induced pulmonary arterial hypertension in rats. Biochem Biophys Res Commun. 2014;452(1):142-6. doi:10.1016/j.bbrc.2014.08.070.
49. Tao S, Huang YQ, Cai AP, et al. Association of Serum Omentin-1 Concentrations with the Presence of Atrial Fibrillation. Med SciMonit. 2016;22:4749-54. PMCID: PMC5142586.
50. Rienstra M, Sun JX, Lubitz SA, et al. Plasma resistin, adiponectin, and risk of incident atrial fibrillation: The Framingham Offspring Study. Am Heart J. 2012;163(1):119-24. e1. doi:10.1016/j.ahj.2011.09.029.