scholarly journals Features of Heart Rate Variability in Patients with Coronary Heart Disease and Risk Factors for Cardiovascular Disease According to the SCORE Charts in the Presence of Heart Rate Turbulence

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
A. I. Vytryhovskyy

The objective of the research was to develop new approaches to the prediction, prevention and treatment of complications in patients at high and very high total cardiovascular risk based on the assessment of heart rate turbulence.Materials and methods. 319 patients were examined to study the role of heart rate turbulence in the formation and progression of sudden cardiac death in the cardiovascular continuum based on the Holter monitoring. All patients were divided into 4 groups: Group 1 included patients with coronary heart disease without concomitant risk factors such as smoking, obesity, metabolic syndrome; Group 2 consisted of patients smoking tobacco for more than 2 years (those at very high cardiovascular risk); Group 3 included patients with metabolic syndrome without existing coronary heart disease or arterial hypertension (those at high cardiovascular risk); Group 4 consisted of 50 patients with metabolic syndrome and arterial hypertension (the control group).Results. In practically healthy people with the phenomenon of heart rate turbulence, there was a high level of sympathetic activity of the autonomic nervous system, which was more pronounced in the passive period of the day. In people with postinfarction cardiosclerosis and the phenomenon of heart rate turbulence hypersympathicotonia being associated with high psycho-emotional stress was typical in the active as well as the passive period of the day; the central mechanisms of regulation prevailed over autonomous ones. In people with coronary heart disease (postinfarction cardiosclerosis) psycho-emotional stress and functional state of the cerebral cortex played an important role in the pathogenesis of the disease. In the passive period of the day, the tension value of the total body regulation decreased, mainly due to high-frequency component of heart rate variability. Hypersympathicotonia and high activity of the vasomotor center at night explain the high incidence of complications and exacerbations of coronary artery disease in the passive period of the day.  In individuals at very high cardiovascular risk according to the SCORE charts with the phenomenon of heart rate turbulence the QT interval lengthening was not observed. The feature of this group was the moderate total tension of heart rate variability in the active period of the day and its rise to the highest limits during the passive period of the day, which was associated with low activity of all spectra. The stress index in patients at very high cardiovascular risk according to the SCORE charts in the passive period of the day reduced compared to the active period of the day. The indices of acceleration and deceleration of the sinus rhythm in patients at very high cardiovascular risk according to the SCORE charts were within normal limits. In individuals at high cardiovascular risk according to the SCORE charts with the phenomenon of heart rhythm turbulence the parameters of heart rate turbulence acceleration were below normal limits; the paramters of deceleration were normal; shortening of the QT interval was not observed.Conclusions. The determination of heart rate turbulence is quite simple, non-invasive, affordable screening method of forecasting the occurrence and development of cardiovascular diseases as well as early detection of patients predisposed to sudden cardiac death in the general population.

2018 ◽  
Vol 25 (1) ◽  
Author(s):  
A I Vytryhovskiy

The objective of the research was to develop new approaches to the prognosis, prevention and treatment of complications in patients at high and very high total cardiovascular risk based on the assessment of the state and effect on heart rate variability and heart rate turbulence.Materials and methods. There were examined 319 patients; they underwent a 24-hour monitoring of their heart rate variability and heart rate turbulence. All the patients were divided into three groups: Group 1 included patients with coronary heart disease (post-infarction cardiosclerosis) without concomitant risk factors such as smoking, obesity, metabolic syndrome; Group 2 consisted of patients smoking tobacco for more than 2 years; Group 3 included patients with metabolic syndrome and arterial hypertension; the control group.Results. In patients with coronary heart disease and concomitant phenomenon of heart rate turbulence, the activity of the parasympathetic nervous system was significantly higher in the active period of the day, while the passive period of the day was associated with the elevated level of stress. Due to this, among patients of this group, there was a decrease in the tension value of the total body regulation in the passive period of the day, while in healthy individuals, its increase was observed. In patients at high and very high cardiovascular risk according to the SCORE charts with the phenomenon of heart rate turbulence, the stress index was significantly higher throughout the day as compared to apparently healthy individuals. In patients at high cardiovascular risk and concomitant phenomenon of heart rate turbulence, the parameters of heart rate turbulence acceleration were significantly higher as compared to those of apparently healthy individuals.Conclusions. In patients at high and very high cardiovascular risk according to the SCORE charts with coronary heart disease and concomitant phenomenon of heart rate turbulence, the occurrence of ventricular extrasystole had a vagal nature; they were characterized by a higher level of stress in the passive period of the day as compared to the active one.


2014 ◽  
Vol 44 (14) ◽  
pp. 2975-2984 ◽  
Author(s):  
F. Zimmermann-Viehoff ◽  
L. K. Kuehl ◽  
H. Danker-Hopfe ◽  
M. A. Whooley ◽  
C. Otte

BackgroundAntidepressants reduce depressive symptoms in patients with coronary heart disease, but they may be associated with increased mortality. This study aimed to examine whether the use of tricyclic antidepressants (TCA) or selective serotonin reuptake inhibitors (SSRI) is associated with mortality in patients with coronary heart disease, and to determine whether this association is mediated by autonomic function.MethodA total of 956 patients with coronary heart disease were followed for a mean duration of 7.2 years. Autonomic function was assessed as heart rate variability, and plasma and 24-h urinary norepinephrine.ResultsOf 956 patients, 44 (4.6%) used TCA, 89 (9.3%) used SSRI, and 823 (86.1%) did not use antidepressants. At baseline, TCA users exhibited lower heart rate variability and higher norepinephrine levels compared with SSRI users and antidepressant non-users. At the end of the observational period, 52.3% of the TCA users had died compared with 38.2% in the SSRI group and 37.3% in the control group. The adjusted hazard ratio (HR) for TCA use compared with non-use was 1.74 [95% confidence interval (CI) 1.12–2.69, p = 0.01]. Further adjustment for measures of autonomic function reduced the association between TCA use and mortality (HR = 1.27, 95% CI 0.67–2.43, p = 0.47). SSRI use was not associated with mortality (HR = 1.15, 95% CI 0.81–1.64, p = 0.44).ConclusionsThe use of TCA was associated with increased mortality. This association was at least partially mediated by differences in autonomic function. Our findings suggest that TCA should be avoided in patients with coronary heart disease.


Author(s):  
G. Krstacic ◽  
A. Krstacic ◽  
M. Martinis ◽  
E. Vargovic ◽  
A. Knezevic ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document