Kaddoussi R. Heart rate variability in heart failure in combination with the remodeling of the myocardium and ventricular arrhythmias

A total of 239 patients, including 95 CAD patients (35 with postinfarction cardiosclerosis (PICS) and 60 with no history of myocardial infarction), 44 patients with arterial hypertension (AH), 59 with noncoronary heart disease and myocardial lesions (33 with myocardiofibrosis, 16 - with dilated (DCM), 10 - with hypertrophic cardiomyopathy), 22 patients with congenital heart defects, 19 - with acquired valvular disease (AVD), and 58 healthy individuals were investigated. Decreased heart rate variability (HRV) was more characteristic for patients with DCM, AVD, AH, PICS, in which the most severe manifestations of the heart failure with the remodeling of the heart chambers and the corresponding changes of structural-functional state of the heart were observed. HRV decreased naturally with the progression of the heart failure regardless of the underlying disease, while the sympathetic-vagal imbalance was amplified with the growth of maladaptive myocardial remodeling. In patients with ventricular arrhythmias significant reduction of circadian index of heart rate and LF/HF was observed, which characterizes the presence of significant autonomic imbalance. In conclusion, the decreased HRV depended of dilatation of the heart chambers with volume overload and decreased contractility of myocardium, accompanied by clinical manifestations of the heart failure.