The state of intracardiac hemodynamics in patients with coronary artery disease and amiodarone-associated thyrotoxicosis

Background. Currently, amiodarone is considered as one of the most effective and safe drugs used in the treatment of patients with various cardiovascular diseases. At the same time, taking amiodarone even in low doses causes side effects, and the risk of their development increases as the duration of the drug administration increases. The main ones include damage to the thyroid gland with the development of both hypo- and hyperthyroidism. The most severe complication arising during therapy with amiodarone is amiodarone-associated thyrotoxicosis (AAT). Hyperthyroidism developing in patients with coronary artery disease (CAD) negatively affects the cardiovascular system (CVS), which significantly worsens the prognosis of the disease. Objective. Assessment of the state of intracardiac hemodynamics in patients with coronary artery disease and developed AAT. Methods. The evaluation of the state of intracardiac hemodynamics in 48 CAD patients during the development of AAT, the achievement of the euthyroid state and at the end of treatment was carried out. Results. The main complaints of CAD patients with identified AAT include irregular and rapid heartbeat. 8.7% of examined patients with postinfarction cardiosclerosis (PICS) did not have any complaints, and the diagnosis of AAT was established on the basis of laboratory and instrumental tests. At the onset of AAT in patients of this group, hypo- and eukinetic types of blood circulation were noted. The further course of thyropathy in this category of patients contributed to the formation of a hypokinetic type of blood circulation. Along with this, in other examined CAD patients, the course of AAT was characterized by the formation of a hypo- and eukinetic type of blood circulation (19.0 and 78.4%, respectively) by the end of the observation. In CAD patients with PICS, there was a 3.3% increase in left ventricular end-diastolic volume (LV EDV) by the period of reaching euthyroidism, and by the end of the follow-up period, there was a 4.1% decrease from the initial parameters. At the same time, the left ventricle end-systolic volume (LV ESV) progressively increased by 6.1%. The ejection fraction (EF) after reaching normal values of basal metabolism increased by 10.1%. Subsequently, there was a significant decrease in the heart pump function (by 14.2% of the initial values). In the group of CAD patients without PICS, a gradual increase in the LV EDVand LVESV was noted. The maximum increase by 7.3 and 12.7%, respectively, was noted by the end of treatment. By the period of reaching euthyroidism, the EF decreased by 10%, by the end of follow-up - by 12.6%. Conclusion. Changes in central hemodynamics in CAD patients with developed AAT vary depending on the clinical form of the disease. In patients with PICS, a hypokinetic type of blood circulation is formed with pronounced structural and functional changes in the myocardium, even when a drug-induced euthyroid state is reached. In CAD patients without myocardial infarction with the developed AAT, changes in intracardiac hemodynamics are characterized by a gradual increase in the volumetric parameters of the left ventricle with a decrease in its pumping function.

coronary artery disease, postinfarction cardiosclerosis (PICS), amiodarone-associated thyrotoxicosis (AAT), central hemodynamics