Heart Rate Variability in Patients with Post-infarction Left Ventricular Aneurysm

The parameters of heart rate variability are known to be widely used for screening the occurrence of ventricular arrhythmia in patients with post-infarction left ventricular aneurysm. However, in literature, there are not much data on changes in heart rate variability in patients with post-infarction left ventricular aneurysm depending on different therapeutic approaches, and this issue is not sufficiently studied. The objective of the research was to study the peculiarities of heart rate variability in patients with post-infarction left ventricular aneurysms depending on therapeutic approach.Materials and methods. We analyzed heart rate variability of 238 patients with post-infarction left ventricular aneurysm. All patients were divided into 3 groups depending on therapeutic approach: optimal basic therapy, patients who underwent percutaneous coronary interventions and those after coronary artery bypass grafting. All patients underwent 24-hours standard ECG monitoring with the analysis of heart rate variability.Results. The study showed that heart rate variability of patients with post-infarction left ventricular aneurysm depended on treatment tactics; hypersympathicotonia was typical. The values of the low-frequency range in patients of Group I and Group III constituted 3103±93.6 ms2 and 3295±45.4 ms2, respectively, which was higher compared to those in the control group and Group II, р<0.05. Parasympathetic influences in patients with post-infarction left ventricular aneurysm were weakened. The analysis of the integral parameters showed that in patients with post-infarction left ventricular aneurysm the autonomous mechanisms of regulation predominated over the central ones. The centralization index was the lowest in patients of Group I and Group II, 2.9±0.3 and 2.3±0.1, respectively, being lower compared to the control group, р<0.05. The other peculiarities were detected as well.Conclusions. The parameters of heart rate variability in patients with post-infarction left ventricular aneurysm were found to depend on treatment tactics. The patients with non-surgical treatment tactics had the most unfavorable heart rate variability characteristics. They developed hypersympathicotonia and high humoral regulatory influences. The application of revascularization when treating patients with post-infarction left ventricular aneurysm using percutaneous coronary interventions can reduce the aggressive sympathetic influences, as well as the value of the Baevsky index. Revascularization with the use of coronary artery bypass grafting does not allow optimizing the autonomous imbalance, although it reduces stress index

ECG Phenomena in Patients with Post-Infarction Left Ventricular Aneurysm

The objective of the research was to study the ECG phenomena in patients with post-infarction left ventricular aneurysm (PLVA) depending on the treatment approach.Materials and methods. We analyzed results of 24-hour ECG monitoring of 238 patients with PLVA. The main group was divided into 3 subgroups depending on the treatment approach: patients who were treated with optimal background therapy (OBT), percutaneous coronary interventions (PCI), coronary artery bypass graft (CABG) surgery. All patients underwent 24-hours standard ECG monitoring.Results. Our research showed that 50.0% of patients of the first group had tachycardia. AV-junction conduction problems often were observed in those persons (PQ interval was 179.7±8.4 ms, which was significantly higher than in the control group, 149.3±5.4 ms, р<0.05). The longest QT interval was also stated for the first group, 532.4±27.3 ms, which was significantly longer than the average values of the control group (438.7±24.6 ms) and the second group (460.2±20.5 ms) respectively, р<0.05. Revascularization procedures (in the second and third groups) allowed achieving heart rate (HR) control in 66.1% and 62.5% of patients respectively. Complete right bundle branch block (CRBBB) was the most frequent phenomenon of patients of the third group (47.9%), which was significantly higher than in the patients of the first and control groups. We also detected a high frequency of supraventricular ectopic complexes in patients of the first and the third groups. A percentage of ventricular ectopic beats was the highest in the third group (17.7%).Conclusions. Patients with PLVA tended to have tachycardia, but the use of LV revascularization procedures allowed improvement of heart rate control. The patients were also characterized by a high percentage of impulse conduction in the atria, “AV-junction” and His bundle branches and the use of LV revascularization procedures did not improve the mentioned phenomena, and increased the risk of ectopic complexes in some cases (after CABG).Patients with PLVA had significantly prolonged “QT-interval” and therefore (along with the frequent disorders of repolarization) increased risk of sudden death. However, the use of LV revascularization (PCI) reduced it significantly

Оцінка якості життя та когнітивних здібностей у хворих з постінфарктними аневризмами лівого шлуночка

A formation of post-infarction left ventricular aneurysm (PLVA) is one of the markers of unfavorable prognosis and one of the leading causes of coronary heart disease mortality [2, 3]. It is believed that half of the cases of ventricular aneurysms involve formation of LV thrombotic masses [5], and this, in turn, may increase the risk of thromboembolism [7], induce subclinical disorders of cognitive abilities and worsen life quality (QOL). That is why we studied in a given subpopulation of patients QOL and cognitive abilities. It was stated that patients with PLVA have worse QOL and decreased cognitive abilities, which to some extent depend on treating strategy. The patients with medicament approach only have the worst QOL. Procedures of LV revascularization improve QOL, but not enough to achieve the quality of control group.Одной из причин смертности от ИБС есть формирование в постинфарктном периоде аневризмы левого желудочка (ПАЛЖ) – маркера, в большинстве случаев, неблагоприятного прогноза [2, 3]. Считается, что половина случаев аневризм ЛЖ сопровождается тромботическими массами [5], а это, в свою очередь, может увеличивать риск тромбоэмболизма [7], а также субклинических нарушений когнитивной функции и качества жизни (КЖ), изучению которых было посвящено наше исследование. По результатам исследования показано, что больные с ПАЛЖ имеют сниженные качество жизни и когнитивные способности, что в значительной мере зависит и от выбранной тактики ведения таких больных. Самое худшее КЖ характерно для лиц с ПАЛЖ и исключительно медикаментозной тактикой лечения. Использование процедур реваскуляризации ЛЖ позволяет улучшить КЖ, которое, правда, не достигает уровня больных без ПАЛЖ.Однією з причин смертності від ІХС є формування у постінфарктному періоді аневризми лівого шлуночка (ПАЛШ) – у більшості випадків маркера несприятливого прогнозу [2, 3]. Вважається, що половина випадків аневризм ЛШ супроводжуються тромботичними масами [5], а це, у свою чергу, може збільшувати ризик тромбоемболізму [7], а також субклінічних порушень когнітивної функції та якості життя (ЯЖ), вивченню яких було присвячене наше дослідження. За результатами дослідження виявлено, що особи з ПАЛШ мають знижену якість життя та нижчі когнітивні здібності, які значною мірою залежать також від обраної тактики ведення таких хворих. Найгірша ЯЖ характерна для осіб із ПАЛШ та виключно медикаментозною тактикою лікування. Використання процедур реваскуляризації дозволяє покращити ЯЖ, яка, проте, не сягає рівня осіб без ПАЛШ