Course of stable coronary heart disease and rhythm disturbance in the post-COVID-19 period

Objective. To study the peculiarities of the course of stable coronary heart disease (CHD) depending on the severity of COVID-19 infection in the acute period and to determine the probability of developing frequent ventricular extrasystole in CHD patients in the post-COVID-19 period. Material and methods. We examined 431 patients diagnosed with stable CHD who had confirmed COVID-19, with a follow-up duration ranging from 3 to 18 months. Patients were divided into two groups based on the severity of COVID-19: Group 1 (n=203) – patients with a mild form of COVID-19; Group 2 (n=228) – patients with a moderately severe form of COVID-19 in the acute period. Clinical, laboratory, and instrumental diagnostic methods were used. Results. Obesity (p=0.005), uncontrolled arterial hypertension (p<0.001), type 2 diabetes mellitus (p=0.007), atrial fibrillation , and chronic heart failure with moderately reduced ejection fraction (p=0.003) were significantly more frequent in Group 2. Multifocal atherosclerosis was detected in 91.3% and 88.5% of patients in Groups 1 and 2, respectively (p=0.416), with hemodynamically significant coronary artery stenoses being more common in Group 2 (86.4% vs. 68.0%, p<0.001). Patients in Group 2 also had a higher incidence of angina pectoris of functional class III (p=0.002). Frequent ventricular extrasystole, associated with a worsening course of CHD, was significantly more frequently recorded in history of Group 2 to Group 1 . Lipid profile parameters were also statistically significantly higher in group 2, which may indicate their role in the progression of CHD in the post-COVID-19 period. The construction of a multivariate logistic regression model demonstrated a statistically significant increase in the odds of frequent ventricular extrasystole if: the longitudinal left atrial size was greater than 5.45 mm, uric acid concentration was greater than 327.7 mmol/L, thyroid hormone levels were greater than 4.14 mU/L, hemodynamically significant coronary artery lesions were present, NT-proBNP levels were greater than 105.5 pg/mL. Conclusion. Patients with stable CHD who have undergone moderate COVID-19 represent a high-risk group for aggravation of the underlying disease and the development of frequent ventricular extrasystole.