Strilchuk L. Autonomic viscero-visceral cardioneuropathy in patients with biliary disorders: prevalence, mechanisms, pathogenesis, clinical polymorphism, and treatment approaches

The paper is dedicated to the estimation of prevalence, clinical manifestations, diagnostic signs, pathophysiological mechanisms, and prognostic impact of biliary autonomous viscero-visceral cadioneuropathy and postbiliary cardioneuropathy together with creating a strategy and tactics of management of such patients. The study showed that the сlinical manifestations of biliary autonomous viscero-visceral cadioneuropathy include damage to the biliary system, tachycardia, arrhythmias, mainly premature beats, a predominance of sympathetic regulation, and a higher risk of cardiosurgical intervention according to EUROSCORE. Coronarographic signs include more frequent and more pronounced stenosis of the right coronary artery and anterior interventricular branch of the left coronary artery. Clinical signs of postbiliary cardioneuropathy include a history of cholecystectomy, tachycardia, arrhythmias, in particular, atrial fibrillation, and prolongation of electrical systole. Coronarographic signs include more frequent involvement of the anterior interventricular branch and a higher degree of damage of the circumflex branch of the left coronary artery. Typical ECG and EchoCG signs were not detected. Compared with biliary autonomous viscero-visceral cadioneuropathy, postbiliary cardioneuropathy was a clinically more favorable condition. In patients with biliary autonomous viscero-visceral cadioneuropathy and postbiliary cardioneuropathy, the cumulative rate of 3-year event-free survival was significantly lower than in patients with the intact gallbladder. Directions for optimizing the strategy of biliary autonomous viscero-visceral cadioneuropathy and postbiliary cardioneuropathy treatment include 1) nutraceutical approach with body weight correction; 2) modified pharmacological effect with the use of β-α-blocker carvedilol, hypolipidemic agents (ezetimibe and statins), ursodeoxycholic acid, pioglitazone; 3) timely cholecystectomy. The use of the proposed treatment for 2-8 months showed sufficient effectiveness. the signs of these cardioneuropathies were identified, the mechanisms of their development were characterized, the prognostic impact was proved, and the optimization of the treatment was proposed. The determined signs of biliary autonomous viscero-visceral cadioneuropathy and postbiliary cardioneuropathy can be routinely used by clinicians. The deterioration of the structural and functional gallbladder condition leads to tachycardia, arrhythmias, inflammation activation, and adverse lipid profile changes, so cardiovascular and rheumatic patients need close attention to the biliary system condition.