EVALUATION OF HEART RATE AUTONOMOUS REGULATION IN PATIENT AFTER MYOCARDIAL INFARCTION

200 coronary patients after a myocardial infarction were studied in order to examine the influence myocardial infarction (MI) localization and depth, as well as sex and age, complications, concomitant conditions and treatment may have on heart rate variability (HRV). HRV was evaluated on the 10-14th day of myocardial infarction with a 5-minutes ECG record. Women demonstrated longer RR intervals, predominant CV, dRR, NN50 and RMSSD, tended to have higher TP and SD, LF/HF, IN and IRV were greater than in men. Thus women had higher parasympathetic tone. Age showed no influence on HRV, most likely because almost all patients were within the same age group (52-62 years). In inferior-posterior MIs as compared to anterior %LF was decreased and %HF, %VLF were higher, reflecting greater vagal tone in inferior MIs. In Q-MIs decreased SD and TP were observed. Concomitant hypertension increased the impact of %VLF, implying switch of regulation to a lower humoral-metabolic level . Concomitant diabetes mellitus decreased NN50, LF/HF, VPR, IRV and IN, reflecting cardiac neuropathy. Exacerbation of heart failure demonstrated worsened HRV and markedly decreased %HF and HFnu, implying parasympathetic influences being most depressed. Early postinfarctional angina was associated with greater LFnu and %LF, also reliably decreasing %VLF which is mot likely due to significant stress of the sympathetic branch. b-Blockers increased RR, increasing RMSSD, NN50 and %HF, demonstrating vagal influence under their action. ACE inhibitors shortened RR increasing HFnu and decreasing %VLF implying activation of the parasympathetic branch of the nervous system with simultaneously decreased humoral and metabolic influences. There were no differences in HRV depending on previous MIs and treatment with aspirin or nitrates. 

1. .Lombardi F. Chaos heart rate variability and arrhythmic mortality // Circulation. – 2000. – Vol. 101. – P.8-10.

2. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart Rate Variability. Standards of Measurements, Physiological Interpretation, and Clinical Use // Circulation – 1996. – Vol.93. – P.1043-1065.

3. Явелов И.С., Травина Е.Е., Грацианский Н.А. Изменения вариабельности ритма сердца, оцененной за короткое время в стандартных условиях у больных, перенесших инфаркт миокарда // Кардиология – 1999.2 № 5. – с.4-11.

4. Malik M. Heart rate variability // Curr. Opin. cardiol. – 1998. . – Vol.13. – P.36-44.

5. Баевский Р.М., Никулина Г.А. Холтеровское мониторирование в космической медицине: анализ вариабельности сердечного ритма // Вестник Аритмологии – 2000. 2 №16. – с.6-16.

6. Ramaekers D., Ector H., Aubert A. E., Rubens A., Van de Werf F. Heart rate variability and heart rate in healthy volunteers. Is the female autonomic nervous system cardioprotective? // Europ. Heart J. – 1998. – Vol.19/9. – P.1334-1341.

7. Pitzalis M., Mastropasqua F., Massari F., Passantino A., et al. Different trend of heart rate variability in patients with anterior and posterior acute myocardial infarction // Pacing. Clin. Cardiology – 1998. – Vol.21/6. – P.1230-1238.

8. Shwartz R.J.The neural control of heart rate and risk stratification after myocardial infarction // Еur. Heart J. 1999. – Vol.1(Suppl.H). – P.33-43.

9. Миронов В.А., Миронова Т.Ф., Саночкин А.В., Миро2 нов М.В. Вариабельность сердечного ритма при гипер2 тонической болезни // Вестник Аритмологии – 1999. 2 №13. – c.41-47.

10. Шитова Н.С., Озеров В.Г., Савельева О.Ю., Глейх И.В. Оценка вегетативной регуляции сердца у больных вто2 рым типом сахарного диабета // Вестник аритмологии – 2000. 2 №17. – c.80.

11. Cerati D., Nador F., Maestry R., Mantica M., Binda A. et al. Influens of residual ischemia on heart rate variability after myocardial infarction // Eur. Heart J. – 1997. – Vol.18. – P.78-83.

12. Nolan J., Flapan A.D., Capewell S. Decreased cardiac parasimpathetic activity in chronic heart failure and its relation to left ventricular function // Br. Heart. J. – 1992. – Vol.67/6. – P.482-485.

13. Keely E.C., Page R.L., Lange R.A., Willard J.E., Landau C., Hillis L.D. Influence of metoprolol on heart rate variability in survivors of remote myocardial infarction // Am. J. Cardiol. – 1996. – Vol.77. – P.557-60.

14. Binkley P.F., Haas G.J., Starling R.C., Nunziata E., Hatton P.A., Leier C.V., Cody J.R. Sustained augmentation of parasympathetic tone with angiotensin converting enzyme inhibitor in patients with congestive heart failure // J. Am. Coll. Cardiol. – 1993. – Vol.21. – P.655-661.

15. Черненкова Е.А., Черненков Р.А., Жуков Г.В., Бондарчук Н.А. Анализ вариабельности сердечного ритма у больных ишемической болезнью сердца и гипертонической болезнью // Вестник аритмологии – 2000. 2 №17. – c. 78.