Prognostic Opportunities of Heart Rhythm Variability Investigation in Patients with Cardio-Vascular Disease

Imanova N. I.

LECTURES

Scentific article

Heart rate variability is one of the indicators of the functional state of the autonomic nervous system. Reduction of this indicator’s levels in some ways is a marker of autonomic deregulation and takes place in the case of diseases associated with an imbalance of the autonomic nervous system. The study of heart rate variability provides an opportunity to improve understanding of the physiological conditions, the impact of treatment and disease mechanisms. Changes in heart rhythm can be assessed using a variety of methods: measures the area of time, statistical, geometrical and frequency methods. Each of these methods has its advantages and disadvantages in certain types of applications. Although cardiac automaticity inherent pacemaker’s different tissues, heart rate and rhythm to a large extent under the control of the autonomic nervous system. HRV is defined as the severity of fluctuations in heart rate (HR) in relation to its average. The clinical significance of HRV was assessed in 1965 when Hon and Lee noted that fetal distress syndrome preceded by changes in the RR- intervals even before there were changes of heart rate directly. Twenty years ago, V. M. Sayers focused on the existence of physiological rhythms, which obeyed the difference between individual blows of heart rate. During the 1970s , invented many simple techniques to identify interval R-R differences to assess autonomic neuropathy in patients with diabetes. Association of higher- risk after myocardial infarction mortality with a decrease in HRV was first defined by M. M. Wolf and his colleagues in 1977. In 1981 – S. Akselrod et al. presented a powerful spectral analysis of heart rate rhythm to quantify the change in control heartbeat. These studies have HR contribution to understanding the background of autonomous oscillations R-R interval heart rate. Parasympathetic division of nervous system, whose influence on heart rate through neurotransmitter acetylcholine and sympathetic division, whose influence is via epinephrine and norepinephrine, interact. At rest predominant parasympathetic activity and changes in heart rhythm are significantly dependent of parasympathetic modulation. Decreased HRV may be associated with different pathologies: heart and diseases of other body systems. Decreased HRV after myocardial infarction may reflect a decrease in parasympathetic influence on the heart, which leads to increased sympathetic influences and electrical instability of the myocardium. One of the hypotheses suggests the inclusion of cardio-cardiac, sympathetic and parasympathetic reflexes, and consists in the fact that changes in the geometry of the heart, which is reduced in the case of areas of necrosis and disturbance of hemodynamics lead to “wrong” excite sympathetic impulses in fibers by mechanical damage of sensory nerve endings. Sympathetic arousal, in turn, reduces the tone of the parasympathetic fibers directed to the sinus node. Another explanation – a decrease of vitality sinus node response to changes in the neural regulation. Diabetes mellitus is one of the causes of autonomic neuropathy. Clinical symptoms consist of signs of damage of sympathetic and parasympathetic nerve fibers and frequently associated with distal sensorimotor polyneuropathy. The course of cardiovascular autonomic neuropathy is asymptomatic nature in 1/5 of patients and appears only in the study of HRV. Cardiac autonomic neuropathy in patients with type 1 diabetes is associated with the activity of the sympathoadrenal system. Moreover, increased activity of sympathoadrenal system is a factor of atherosclerosis in adult patients regardless of the presence of diabetes. Increased blood pressure combined with adverse electrophysiological phenomena in the myocardium of the left ventricle, associated with its hypertrophy and dysfunction of the autonomic nervous system. The risk of cardiac autonomic neuropathy is depend on the duration of diabetes and degree of glycemic control and increases in parallel with the development and progression of complications of other diseases such as retinopathy, nephropathy, vasculopathy and others. Therefore, the holding of periodic 24-hour Holter measurement can detect minor violations of autonomic balance in a timely manner and appropriately adjust the development of pathology. Individual prediction value based on the HRV is small. However, the combination with other methods significantly improves the positive predictive accuracy of the HRV (by clinical sensitivity range of 25% to 75%) for cardiac death and arrhythmias. HRV has significant potential for impact assessment of the role of vegetative nervous system in healthy subjects and in patients with various cardiovascular and non-cardiovascular disorders. The study of HRV provides an opportunity to improve our understanding of the physiological conditions, the impact of treatment and disease mechanisms. Heart rate variability research needed to determine the sensitivity, specificity and predictive value of the method in the distribution of individuals in relation to the threat of disease and death in the future.

heart rate variability, cardio-vascular diseases, vegetative nervous system

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