Comparison of dynamic of autonomic control indices in cardiovascular system under the treatment by ACE inhibitor (Enalapril) and beta-blocker (Metoprolol) in patients with hypertension

The objective of the present research was to compare the influence of Enalapril and Metoprolol on synchronization of 0.1 Hz-regulation of heart and blood microcirculation. 42 patients aged 49±9 years old with hypertension I, II were included in the study. 0.1 Hz-oscillations in heart rate variability (HRV) and blood microcirculation were registered during the passive orthostatic sign while breathing spontaneously. The duration of each test was 10 minutes. Synchronization was estimated as a phase difference between 0.1 Hz-rhythms in heart rate and in filling of blood microcirculation. Quantitative measures of synchronization were also estimated. In addition frequency values of HRV spectrum in LF- and HF-ranges were assessed. Enalapril and Metoprolol had comparable effect on blood pressure reduction. Treatment with both Enalapril and Metoprolol in patients with significant vegetative dysfunction resulted in repair of functional interaction between 0.1 Hz-regulation of heart and blood microcirculation. Enalapril was preferred in hypertensive patients with prevalence of disorders of vegetative regulation of blood microcirculation. Metoprolol influenced positively on 0,1 Hz-rhythm synchronization in patients with predominance of heart vegetative regulation dysfunction and in patients with sympathicotonia. In patients with hypertension and initially normal level of synchronization of 0.1 Hz-mechanisms treatment with Enalapril or Metoprolol caused functional dissociation. Differentiated approach to the choice of hypertensive therapy should consider individual peculiarities of system vegetative dysfunction. The level of synchronization of 0.1 Hz-rhythms in cardiovascular system should especially be evaluated initially and during the treatmen

Comparative evaluation of autonomic regulation of circulation in patients undergone coronary artery bypass grafting or correction of acquired valvular heart disease

The aim of the research was to study the peculiarities of vegetative regulation of blood circulation in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or correction of acquired valvular heart disease (CAVHD). Material and Methods. In this study we included 42 patients (12 women; 63 (57; 67) years), who underwent CABG, and 36 patients (16 women; 58 (47; 65) years) who underwent CAVHD. The synchronous 15 minutes records of electrocardiogram and photoplethysmogram (PPG) were performed in all patients before and after surgery. Time domain and frequency domain measures of heart rate variability (HRV) and index of synchronization between low-frequency (LF) oscillations in HRV and PPG (index S) were analyzed. Results. Most studied autonomic indices did not have statistically significant differences between patients with CABG and CAVHD in the study stages, except for heart rate, which was higher in patients before CAVHD (p=0,013). Conclusion. The values of HRV and index S do not depend on the difference in the clinical status and the features of performed cardiac surgical interventions between patients with CABG and CAVHD.</p

Clinical Effectiveness Of Dynamic Out-Patient Control Technology Over Hypertensive Patients Based On Computer System And Mobile Phone Connection

A new follow-up technology of dynamic out-patient control based on system of mobile monitoring of patients with arterial hypertension (SMMAH) has been created in Saratov Scientific Research Institute of Cardiology. SMMAH is based on exchange of information between patient and doctor with the help of Internet and standard short mobile messages. The aim of the present work is to study the effectiveness of SMMAH for follow-up control of hypertensive patients for the period of 12 months. 79 patients with hypertension aged 49±11 were included in the investigation. Control period lasted 12 months. Control visits were made in the 1st, 6th and 12th months. The number of patients became out of control, its causes, percentage of patients who achieved and maintained target blood pressure (BP) were analyzed after each visit. Data were presented as M (95% confidence interval). As a result in 1 month period of investigation 88,6% of patients regularly used mobile messages, 11% of patients were out of control. In 6 months period 68,4% of participants were under control, 31,6% of patients dropped out. In 12 months period — 67% and 33% of patients accordingly. Target BP was maintained in 87% (77%-96%) of patients in 1 month period, in 78% (66%-90%) of patients in 6 months period and in 68% of patients (53%-84%) in 12 months period. High clinical effectiveness of SMMAH has been proved during the study: 67% of patients have followed prescribed therapy after the investigation period and 68% of them have maintained target BP level

Evaluation of five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction on basis of 0.1-Hz rhythms synchronization in cardiovascular system

The research goal is to evaluate the impact of autonomic heart control indices on five-year risk of lethal outcome and development of cardiovascular disorders in patients with acute myocardial infarction (AMI) and to study the dynam¬ics of indices in short- and long-term period. 125 patients with AMI (42% female), ages 30 to 83 years, were enrolled in prospective observational study. Observation period lasted 6 years. Control checking was carried out in 1 week, 3 weeks, 6 months, 1 year and then annually. The dynamics of heart rate variability (HRV) and the synchronization of 0.1-Hz rhythms of heart and microcirculation (S) were studied during the first year. Outcomes proved to be death, MI, stroke. Development of acute heart failure Killip 2-4 and indices S &lt; 20% during the first week of AMI (х2 = 10,5, p = 0,005 for the Cox model) played a significant role in evaluation of five-year risk of death after AMI. Sensitivity (Se) and specificity (Sp) of index S &lt; 20% during the first week of AMI were 76% and 43% correspondingly. The Cox model showed that indices of HRV and 0.1-Hz rhythms synchronization were not of great value in evaluation of five-year risk of death after AMI. The article concludes that indices S &lt; 20% in patients with AMI possess better prognostic value than common clinical parameter

Statin therapy in the primary prevention of early atrial fibrillation after coronary artery bypass grafting

Objective: Assessment of the role of statin therapy in the prevention of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients without prior atrial fibrillation. Methods: A retrospective analysis of 206 patients, aged 57.2 ± 7.9 years (mean ± SD), who underwent isolated CABG is carried out. All patients are divided into two groups. The first group (nSt-patients) includes the patients who did not receive statin therapy prior to CABG (n = 82). The second group (St-patients) includes the patients who received statin therapy prior to CABG (n = 124). Both groups received the statin therapy from the first day after CABG. The risk of occurrence of POAF is evaluated using the Cox-regression model. Results: The rate of POAF was 25.6% in nSt-patients and 6.5% in St-patients (P = 0.020). On the 4th day after CABG, white blood cells (WBC) count was 11.0 (9.0, 13.0) × 109/mL (medians with inter-quartile ranges) in nSt-patients and 9.0 (7.6, 10.2) × 109/mL in St-patients (P < 0.001). The peak WBC numbers occurred on the day of POAF onset. The Cox-regression analysis shows that only two factors (statin therapy and number of grafts) had significant influence on the POAF onset. Odds ratio of POAF event prediction by statin therapy was 0.20 (95%CI: 0.08–0.51), P < 0.001. Each subsequent graft increased the risk of POAF in 2.1 times. Conclusion: Statin therapy carried out prior to the CABG is an effective approach to primary prevention of POAF in early postoperative period. Statin therapy after CABG in nSt-patients does not give prophylactic effect observed in St-patients

Investigation of statistical characteristics of interaction between the low-frequency oscillations in heart rate variability and peripheral microcirculation in healthy subjects and myocardial infarction patients

Objective. This study compares the statistical characteristics of interaction between 0.1 Hz oscillations in heart rate variability (HRV) and photoplethysmogram (PPG) in healthy subjects and myocardial infarction (Ml) patients. Material and methods. We studied 23 healthy subjects (20 men and 3 women aged 26±3 years) and 23 patients (12 men and 11 women aged 52±4 years) at about one month after Ml. The 10-minute signals of simultaneously recorded cardioin-tervalogram (CIG) and PPG were studied. We calculated the total percentage of phase synchronization between the studied 0.1 Hz oscillations and estimated the distribution functions of duration of synchronous and non-synchronous epochs, the variability of basic frequency of oscillations, and variance of phase noises in 0.1 Hz oscillations in HRV and PPG. Results. The total percentage of phase synchronization between 0.1 Hz oscillations is significantly greater in healthy subjects than in Ml patients (47±3% and 26±4%, respectively). Significant difference between these two groups in the distribution of duration of synchronous and non-synchronous epochs was not revealed. The Ml patients had greater variance between the basic frequencies of 0.1 Hz oscillations in HRV and PPG than healthy subjects. This phenomenon correlates with the increased level of phase noises in the records of Ml patients. Conclusion. The quality of synchronization between 0.1 Hz oscillations in HRV and PPG is associated with the strength of influence of external factors (noises) and variability of the basic frequency of these oscillations