2013


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2013/№3

Time course in parameters of autonomic regulation, T-wave alteration and obstructive sleep apnea in patients with Q-wave myocardial infarction and ventricular rhythm disorders

Logacheva I. V., Barantseva N. G.

Keywords: T-wave alternans, autonomic balance, myocardial infarction, obstructive sleep apnea

DOI: 10.18087/rhj.2013.3.1759

Background. Comprehensively evaluated noninvasive stratification of RF for ventricular rhythm disorders (VRD) of different grades determined the severity of arrhythmic syndrome following MI. Aim. Studying the time course of heart rate variability (HRV), microvolt T-wave alternans (mvTWA), and sleep apnea in MI patients with different grades of VRD. Materials and methods. 70 men aging 38 to 60 years (52.6±1.3 years) with primary acute MI and grades 1–5 VRD (acc. to B. Lown) were examined. The control group included 40 male subjects without IHD signs. Patients were divided into three groups based on the severity of arrhythmic syndrome: А1 (n=29), grades 1–2 VRD; А2 (n=23), grades 3–4 VRD; and А3 (n=18), paroxysmal ventricular tachycardia (VT). Follow-up evaluations were performed at 10–14 days and 6 months after MI. 24h ECG monitoring was used to study HRV and mvTWA, episodes of apnea-hypopnea were recorded, and autonomic functional tests were performed. Results. The presence of mvTWA and sleep apnea on days 10–14 of MI indicated high-grade VRD. In the subacute MI period, depressed parasympathetic input and significant sympathicotonia were revealed and confirmed by autonomic tests. A close correlation was observed between parameters of autonomic regulation, mvTWA, and the apnea-hypopnea index (AI). The correlation power increased with VRD severity. At 6 months after MI, patients with high-grade ventricular arrhythmia showed increased autonomic imbalance and the absence of beneficial changes in mvTWA values. Conclusion. In patients with Q-wave MI (subacute stage), autonomic dysfunction, intensity of mvTWA, and severity of obstructive sleep apnea are mediated by the grade of VRD. At 6 months after MI, patients with grades 1–2 VRD showed beneficial changes. Autonomic dysfunction and disturbed processes of myocardial repolarization remained in patients with life-threatening arrhythmias.
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Logacheva I. V., Barantseva N. G. Time course in parameters of autonomic regulation, T-wave alteration and obstructive sleep apnea in patients with Q-wave myocardial infarction and ventricular rhythm disorders. Russian Heart Journal. 2013;12(3):142-147

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