Mathematical program for predicting the risk for progression of atrial fibrillation and its possible complications in patients with hypertension and concomitant extracardiac diseases

Objective. To elaborate a personalized algorithm for predicting the progression of atrial fibrillation (AF) and the development of its complications in essential hypertension concurrent with extracardiac diseases. Subjects and methods. An observational cohort study involved 308 males aged 45-60 years with AF and hypertension concurrent with extracardiac diseases: diabetes mellitus (n=40), diffuse toxic goiter (n=42); hypothyroidism (HT; n=59), abdominal obesity (n=64), and chronic obstructive pulmonary disease (n=47). A comparison group consisted of 56 patients without extracardiac disease. The study assessed clinical, laboratory, and anthropometric data and 24-hour ECG monitoring and echocardiography readings. All statistical calculations were performed using the Rstudio program (USA). Results. Significant predictors of AF progression have been established, which include remodeling indicators: a 1-ng/l elevation of galectin-3 increases the risk of AF progression by 1.003 times (p=0.016); a 1-cm left atrial (LA) enlargement does by 2.67 times (p<0.001); a 1-cm increase in end-diastolic dimension reduces the risk of recurrent AF by 0.13 times (p=0.025); a 1-g/m2 elevation of the left ventricular mass index enhances the risk of AF progression by 0.9 times; which also include inflammation indicators: a 1-pg/l elevation of interleukin-6 increases the risk of AF progression by 0.6 times; a 1-n/ml increase in matrix metalloproteinase-9 as a marker of vascular stiffness does by 0.16 times. Emergency hospitalization for the progression of chronic heart failure (CHF) within 1 year in patients with AF was significantly higher in all the clinical groups than in the controls, except for the HT group. There were statistically significant predictors of hospitalization for CHF progression: a 1-cm LA enlargement increases the risk of CHF by 5.04 times; a 1-pg/l elevation of NT-proBNP does by 1.01 times. A comparative assessment of the incidence of cardiac embolism in the examined groups showed no statistically significant difference; however, it was on percentage terms higher in patients with AF than in those without the latter (11.2 and 6%, respectively). Conclusion. The elaborated personalized algorithm can assist in assessing the prognosis of the progression of AF and the development of its complications in essential hypertension concurrent with extracardiac diseases.