Virtual Conference
Heart 2022 Conference

Vytryhovskiy A

?vano-Frankivsk regional cardiological center, Ukraine

Title: Deceleration capacity - A marker prognosis of sudden cardiac death in smoking patients


Decreased deceleration capacity is a powerful prognostic factor for mortality after myocardial infarction (MI).

The aim of the study was to determine whether the Phase-rectified signal averaging (PRSA) study,  has the predictive ability to predict arrhythmic risk of sudden death in patients with only existing cardiovascular risk factors, namely smokers. 

Materials and methods: In the period 2007-2018, were analyzed Holter ECG monitoring of heart rate variability (HRV) and heart rate turbulence (HRT) and Phase-rectified signal averaging (PRSA) study of  923 patients. The mean age of the patients was 63,3 ± 9,11 years. All patients were divided into groups: 1st - patients with coronary heart disease (post-infarction cardiosclerosis), but without concomitant risk factors - smoking, obesity, metabolic syndrome, this group included 72 patients with signs of  HRT and 163 - without it. Group 2 included patients who smoked tobacco for more than five years (subjects with very high cardiovascular risk on the SCORE scale) in this group were 69 people with HRT and 85 people without the phenomenon. Group 3 included patients with metabolic syndrome and concomitant arterial hypertension (subjects with high cardiovascular risk on the SCORE scale) in this group included 138 people with HRT and 246 without it. The control group included 100 practically healthy individuals in the HRT study and 50 without it. There were no gender or age differences between the groups. 

Results: In this study it was found that among persons without concomitant HRT, the lowest levels of aceleration capacity (AC) and deceleration capacity (DC) coefficients were recorded in the group of persons with previous myocardial infarction. When comparing groups with risk factors and acute MI, there is no significant difference in the magnitude of these coefficients in the past. In the analysis of AC and DC indices of persons with existing HRT, the following features were established - in practically healthy persons at night, the period of physiological parasympatheticotonia, the difference between DC and AC indices increases, then among persons with risk factors for the occurrence of cardiovascular diseases on the contrary the difference decreases. This phenomenon is especially characteristic in group 2 (smokers) among persons with a HRT. The highest percentage of persons with prognostic-adverse DC level was among persons with post-infarction cardiosclerosis and this feature is seen in both subgroups, individuals with and without HRT. The decrease in the protective effect of the vagus nerve is more characteristic of individuals with the phenomenon of HRT than without it. The AC and DC coefficients in the HRT subgroups were both lower in absolute and relative terms than in those without it. 

Conclusion: During the transformation of risk factors into diseases in cardiovascular continuum, became changes in the autonomic system, with loss of antifibrillatory properties of the body. The most unfavorable period of the day to reduce the anti-fibrillation effect on the heart in people with very high cardiovascular risk (smokers) is the night period.


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