S.D. MAYANSKAYA¹, K.A. RAKOV¹, A.F. USMANOVA¹, A.A. GILMANOV², A.YU. TEREGULOV²

 ¹Kazan State Medical University, Kazan

²Republic Clinical Hospital, Kazan

Contact details:

Mayanskaya S.D. — MD, Professor of the Department of Hospital Therapy

Address: 49 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-905-316-99-66, e-mail: Smayanskaya@mail.ru

The difficulty of coronary artery disease (CAD) diagnosing in patients with atrial fibrillation (AF) is due to a number of factors. ECG, ECG Holter monitoring (HM), stress tests and echocardiography (Echo) are not valid for detecting CAD against the background of this rhythm disorder. However, their widespread use for diagnosis verification leads to significant hyperdiagnosing of coronary heart disease with AF.

The purpose was to compare the state of coronary blood flow in patients with different forms of AF and the presumptive diagnosis of acute coronary syndrome during emergency hospitalization of patients, using coronary angiography (CAG).

Material and methods. We examined 112 patients with AF admitted to the Republic Clinical Hospital of Kazan by emergency, of which 57 persons had paroxysmal AF (group 1) and 55 had permanent AF (group 2). EchoCG and CAG were performed for all patients.

Results. During the examination, intact coronary arteries (CA) were detected in 54 patients, largely in those with permanent AF, which indicated significant overdiagnosing in these patients. Hemodynamically significant stenoses >50%, myocardial infarctions, postinfarction cardiosclerosis of the anterior interventricular branch of the left CA were most often detected in the first group, and of the right CA — in the second group of patients.

Conclusion. Thus, the presence of AF does not always indicate the hemodynamically significant stenosis in the CA, and, therefore, always requires confirmation using CAG or computed tomography of the coronary vessels.

Key words: atrial fibrillation, ischemic heart disease, coronary angiography, coronary artery stenosis.

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