Specificity of the effect of double fractures of the rhythmogram on the daily variability of the sinus rhythm in patients with pulmonary and arterial hypertension

Introduction. In contrast to coronary heart disease (CHD), heart failure and a number of other diseases, in arterial and pulmonary hypertension, the deterioration of the functional state of the patient is often not accompanied by a decrease in the parameters of his sinus rhythm variability (SRV) for long periods of time. Moreover, an increase in age and an increase in blood pressure in patients with hypertension may lead not to a decrease, but to an increase in the parameters of daily SRV. It is noted that with hypertension on the sinus rhythm, the number of so-called double fractures of the rhythmogram (DFR) - sequences of RR intervals «short-long-short-long» - becomes greater, which can greatly affect the daily SRV. Aim. To study the specifics of the effect of DFR on daily SRV in arterial and pulmonary hypertension. Materials and methods. 300 Holter ECG records were analyzed, including 67 records of healthy persons, 20 records of CHD patients with CAG-confirmed vascular damage, 126 records of patients with arterial hypertension and 87 records of patients with idiopathic pulmonary hypertension. In the analysis of daily SRV, a modification of the SRV analysis method developed at the National Medical Research Center of Cardiology, taking into account the presence of DFR, was used. Results. It is shown that DFR reflects the processes of regulation of the sinus rhythm, which are affected differently by CHD and hypertension. In CHD, the frequency of DFR and its effect on the daily SRV significantly decreases (compared to the norm). With hypertension, the frequency of the appearance of DFR increases; there is a clear trend towards a decrease in SRV in comparison with the norm in the areas without DFR; in areas with DFR, this trend is less pronounced or absent, and at ages over 50 years, SRV increases. Conclusion. When studying the daily SRV of patients with arterial and idiopathic pulmonary hypertension, it is necessary to take into account the effect of DFR on the increase in SRV.

heart rate variability, coronary heart disease, arterial hypertension, pulmonary hypertension

1. Baevsky RM, Berseneva AP. Assessment of the body’s adaptive capabilities and the risk of developing diseases. Moscow: Medicine, 1997 (in Russian).

2. Baevskii RM. Analiz variabel’nosti serdechnogo ritma pri ispol’zovanii razlichnykh elektrokardiograficheskikh sistem (metodicheskie rekomendatsii). Vestn. aritmologii. 2001; 24: 66–85 (in Russian).

3. Baevsky RM, Kirillov OI, Kletskin SZ. Mathematical analysis of changes in heart rate during stress. Moscow: Nauka, 1984 (in Russian).

4. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the European society of cardiology and the North American society of pacing and electrophysiology. Eur Heart J 1996; 17: 354–81.

5. Makolkin VI, Zyabrev FN. Could heart rate be considered a risk factor for cardiovascular disease? Cardiovasc. therapy and prevention. 2006; 5 (6): 5–9 (in Russian).

6. Wolf MM, Varigos GA, Hunt D, Sloman JG. Sinus arrhythmia in acute myocardial infarction. Med J Aust 1978; 2: 52–3.

7. Sobolev AV. Methods for analyzing heart rate variability over long periods of time. Moscow: Medpraktika, 2009 (in Russian).

8. Ryabykina GV, Sobolev AV. Holter and bifunctional monitoring of ECG and blood pressure. Second edition. M .: Medpraktika-M, 2016 (in Russian).

9. Sobolev AV. Analysis of the variability of the heart (sinus) rhythm. In the book: Functional diagnostics. National leadership. Ed. NF Beresten, VA Sandrikov, SI Fedorova. Moscow: GEOTAR-Media, 2019 (in Russian).

10. Medvedev AP, Gavrilushkin AP, Maslyuk AP, et al. Analysis of heart rate variability in athletes. Tutorial. N. Novgorod: Publishing house of Nizhny Novgorod honey. academies, 1999 (in Russian).

11. Sobolev AV, Riabykina GV, Kozhemiakina ESh. Novyi metod analiza variabel’nosti sinusovogo ritma na dlitel’nykh promezhutkakh vremeni, uchityvaiushchii nalichie na ritmogramme dvoinykh izlomov. Sovremennaia funktsional’naia diagnostika. 2017; 1: 22–6 (in Russian).