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Special features of neurogenic control of the heart in patients with severe heart failure: interrelation of efferent reactivity potential and baroreflex regulation of a heart rhythm

Mamontov O. V., Kozlenok A. V., Kozlova S. N., Shlyakhto E. V.
Federal State Budgetary Institution, “North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: baroreflex dysfunction, diagnostics, neurogenic heart control, CHF

DOI: 10.18087/rhfj.2012.4.1705

Relevance. Neurogenic heart regulation disorder can be connected both with baroreflex dysfunction and with decreased neurogenic reactivity, and the intensity remains more often unclear. Objective. Define character and intensity of the heart rhythm neurogenic control disorder and estimate clinical pathogenetic value of various factors of chronotropic dysfunctions in patients with severe CHF. Materials and methods. 40 patients with CHF II–IV FC, EF 35.4±14.8 %, average age 56.4±8.1, were studied. 55 % patients had coronary, 33 % – noncoronary, and 12 % combined myocardial pathology. All patients underwent examination of the heart autoregulation: tilt-test, estimation arterial baroreflex (ABR), Valsalva’s index (VI). Parameters were registered by BP monitor Finometer (FMS) with parallel recording of electrocardiogram and subsequent spectral analysis of cardiac rhythm (HRV). Results. It has been revealed that patients in comparison with a group of volunteers comparable by age had reduced ABR (6.1±2.8 and 10.1±5.4 ms / mm Hg, р<0.001) and VI (1.41±0.26 and 1.84±0.37, р<0.001), as well as HRV in all frequency ranges. In the control group, correlation between general HRV and VI (r=0.43; p<0.005) was established, but stronger connection with ABR level (r=0.58; p<0.001). In CHF patients, strong correlation of general HRV with VI was also revealed: r=0.59; p<0.001, still HRV was not connected with ABR level in any range. Strong connection of VI with FC was established in patients (F=3.4; p<0.05) and CHF stage (F=13.5; p<0.001), EF (r=0.47, p<0.005), LV systolic and diastolic volume (r = –0.48; p<0.005 and –r = –0.46; p<0.005 respectively), and also BNP level (–r = –0.49 p=0.001). On the other hand, VI had inverse relationship with the intencity of ventricular arrhythmia according to М. Ryan classification (F=2.6, p<0.05) whereas ABR was connected with angina FC (F=4.2, p<0.05). Conclusion. At severe CHF, regulation of cardiac rhythm is limited by the efferent chronotropic potential which reduction is caused by contractility disorder and is associated with factors of a bad forecast while arterial baroreflex dysfunction is connected with intensity anginous syndrome. Valsalva’s index can be used for screening estimation of myocardial lesion severity in CHF patients.
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Mamontov O. V., Kozlenok A. V., Kozlova S. N. et al. Special features of neurogenic control of the heart in patients with severe heart failure: interrelation of efferent reactivity potential and baroreflex regulation of a heart rhythm. Russian Heart Failure Journal. 2012;13(4):213-221

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