clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2023-101-12-630-636clinmed-697Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSСтруктура нарушений сердечного ритма у пациентов с ожирениемStructure of cardiac rhythm disorders in patients with obesity and associated with it dyslipidemia as an arrhythmogenic factorhttps://orcid.org/0000-0002-7220-4745ПановаЕ. И.PanovaE. I.

Панова Елена Ивановна — д-р мед. наук, профессор кафедры эндокринологии и внутренних болезней

603000, Нижний Новгород

Elena I. Panova — Doctor of Medical Sciences, Professor of the Department of Endocrinology and Internal Medicine

603000, Nizhny Novgorod

https://orcid.org/0000-0002-8302-2218МорозоваЕ. П.MorozovaE. P.

Морозова Елена Павловна — канд. мед. наук, доцент кафедры эндокринологии и внутренних болезней

603000, Нижний Новгород

Elena P. Morozova — Candidate of Medical Sciences, Associate Professor of the Department of Endocrinology and Internal Medicine

603000, Nizhny Novgorod

ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава РоссииРоссияPrivolzhsky Research Medical University of the Ministry of Health of the RussiaRussian Federation20232202202410112630636Copyright © Панова Е.И., Морозова Е.П., 20242024Панова Е.И., Морозова Е.П.Panova E.I., Morozova E.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/697

Ожирение — глобальная проблема общественного здравоохранения в XXI веке. Наиболее неблагоприятные эффекты связывают с его висцеральным типом, с накоплением метаболически активного эпикардиального жира и формированием липотоксической кардиомиопатии, сопряженной со значимыми морфофункциональными изменениями миокарда, клинически сопровождающимися высоким риском развития нарушений сердечного ритма. Цель исследования: выявить структуру (частоту и характер) нарушений сердечного ритма у мужчин трудоспособного возраста с андроидным ожирением, изучить связь аритмий с особенностями липидного спектра крови пациентов. Материал и методы. Обследовано 98 молодых мужчин с висцеральным ожирением и 46 мужчин с избыточной массой тела. Группу контроля составили 40 здоровых мужчин с нормальной массой тела. Всем больным проводилось ЭКГ-мониторирование, ЭхоКГ и определение уровня липидов сыворотки крови. Результаты. Наличие ожирения статистически значимо ассоциировано с риском развития парных наджелудочковых экстрасистол, частых желудочковых экстрасистол, синусовой аритмии, фибрилляции предсердий. Нарастание степени тяжести ожирения сопровождалось тенденцией к большей частоте аритмий: при ожирении I степени частота фибрилляции предсердий составила 12,3%, II–III степени — 21,2%, р = 0,25; частая желудочковая экстрасистолия при аналогичных степенях ожирения — 13,8 и 21,1% соответственно. Фибрилляция предсердий существенно чаще выявлялась на фоне липидных нарушений, преимущественно при снижении холестерина липопротеинов высокой плотности. Заключение. Основным типом нарушения ритма сердца у больных с ожирением являются суправентрикулярные аритмии, преимущественно фибрилляция предсердий, частота возникновения которой возрастает пропорционально увеличению массы тела пациента. Абдоминальное ожирение приводит к увеличению желудочковой эктопической активности. Дислипидемия является одним из факторов риска формирования нарушений ритма у этих пациентов.

Obesity is a global public health problem in the twenty-first century. The most adverse it’s effects are associated with visceral type, with accumulation of epicardial fat, showing high metabolic activity, dysfunction and important role in the development of lipotoxic cardiomyopathy linked with significant morphological and functional myocardial changes, accompanying by high risk of heart rhythm disorders. The aim of the study: to identify structure (frequency and character) of cardiac arrhythmias in men of employable age with visceral obesity, to establish the relationship of arrhythmias with features of the blood lipid spectrum of these patients. Material and methods. 98 men with abdominal obesity and 46 overweight patients were examined. The control group consisted of 40 healthy patients with normal body weight. All the patients were undergone ECG monitoring, echocardiography and analysis of serum lipid levels. Results. The presence of obesity is statistically significantly associated with the risk of supraventricular couplets, frequent ventricular extrasystoles, sinus arrhythmia and atrial fibrillation. The increase in the severity of obesity was accompanied by a tendency to a greater frequency of arrhythmias: in obesity of I degree, the frequency of atrial fibrillation was 12.3%, II–III degree — 21.2%, p = 0.25; frequent ventricular extrasystoles with similar degrees of obesity — 13.8% and 21.1%, respectively. Atrial fibrillation was significantly more often detected against the background of lipid disorders, mainly with a decrease in HDLP. Conclusion. The main type of heart rhythm disturbance in patients with obesity are supraventricular arrhythmias, mainly atrial fibrillation, the frequency of which increases in proportion to the increase in the patient's body weight. Abdominal obesity leads to an increase in ventricular ectopic activity. Dyslipidemia is the one of risk factors for arrhythmias in these patients.

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The authors declare that there are no conflicts of interest present.