Influence of status of heart rate autonomic control on the course of the post-infarction period and cardiac rehabilitation

Aim. To study the effect of heart rate variability parameters recorded in the acute ST-segment elevation myocardial infarction (STEMI) on the prognosis; to study laboratory and functional markers of heart failure. Material and methods. The study included 199 people. The comparison group of 79 healthy volunteers was necessary to determine the normal ranges of heart rate variability. One hundred and twenty patients on the 7th-9th day, the 24th and the 48th week of STEMI underwent a 12-lead Holter monitoring with an assessment of time parameters of heart rate variability. In the same periods, blood tests for brain natriuretic peptide (BNP) and highly sensitive C-reactive protein (hs-CRP) were performed every 12 weeks. Observations evaluated the distance in the 6-min walk test, as well as the quality of life using the Minnesota and Seattle questionnaires.

Results. Depending on the values of heart rate variability on the 7th-9th day, all patients with STEMI were divided into 2 groups: group “S” — with a sympathetic predominance, group “N” — with balanced neurohumoral effects. We revealed twofold BNP decrease in group “H” patients by 24th week and subsequent visits. In group “S” patients, BNP levels remained high throughout the observation period. The level of hs-CRP returned to normal range by 24th week of observation in all patients. Tolerance to physical activity in group “S” was initially lower than in patients of group “H”, but by the 48th week the walking distance gradually became equal in both groups. The prevalence of ventricular tachycardia and the quality of life between groups did not statistically differ. The risk of recurrent cardiovascular events and deaths in group “S” was significantly higher than that in group “H”. Conclusion. Enhanced sympathetic activity on the 7th-9th day of STEMI was associated with an increased risk of recurrent cardiovascular events, and also adversely affected changes of heart failure laboratory markers — BNP and hs-CRP.

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