Cardiovascular Risk Factors when Using Modern Chemotherapy Regimens in Comorbid Patients with Multiple Drug-Resistant Tuberculosis

The objective: to evaluate predictors of cardiotoxicity when using modern chemotherapy regimens in comorbid patients with multiple drug-resistant tuberculosis (MDR TB) to identify a group facing a high risk of cardiovascular events. Subjects and Methods. A single-center, open-label, controlled prospective cohort study was conducted. A total of 87 MDR TB patients were enrolled and divided into 2 groups: Group 1 included 24 patients whose QT interval length exceeded 450 ms at one or more control points; Group 2 included 63 patients whose QT interval duration length was less than 450 ms at all observation periods. Results. In this study, traditional risk factors for QT prolongation, such as: overweight or underweight, smoking, hypokalemia, bradycardia, taking two QT-prolonging anti-tuberculosis drugs (fluoroquinolone and bedaquiline) and in combination with capreomycin, did not provide a significant effect on the development of cardiotoxic reactions during anti-tuberculosis chemotherapy. The risk of QT prolongation and related cardiovascular complications was significantly associated with comorbid cardiovascular diseases (CVD) (OR=4.29, CI 1.46–12.56; p =0.009), a family history of CVD (OR=4, CI 1.26–12.72; p =0.024), chronic obstructive pulmonary disease (OR=2.9, CI 1.1–7.67; p =0.033), and female gender (OR=3.73, CI 1.38–10.07; p =0.015). The identified predictors, even at the stage of compiling an anti-tuberculosis regimen, make it possible to identify a risk group for developing cardiotoxic reactions among MDR TB patients.