Heart rate variability in patients with chronic rheumatic heart disease

Objective. Evaluation of heart rate variability in patients with rheumatic heart disease.

Material and methods. The study enrolled 230 patients, of whom 156 patients with mitral stenosis (CRHD), 36 patients with mitral valve regurgitation, and 38 patients with acquired aortic stenosis were selected. CHF functional class was determined using a 6-minute walk test according to the standard method; there were no patients with FC IV. HRV values were obtained using the Kardiotekhnika-04-3R (M) cardiorespiratory monitor with an estimation of time domain and frequency domain.

Results. The CRHD patients had lower HRV indicators in the time (SDNN - 126.38 ms, SDANN - 112.07 ms, RMSSD - 32.79 ms) and frequency domain (VLF - 2,098.59 ms²; LF - 865.39 ms², HF - 323.48 ms²) compared with patients with mitral valve regurgitation and aortic stenosis. Evaluation of HRV within patients with CRHD, depending on the presence or absence of combined mitral-aortic stenosis, did not show differences in the general and sympathetic tone of the ANS. In patients with combined mitral-aortic stenosis, only a decrease in parasympathetic tone was revealed: RMSSD - 31.18 ms, HF - 286.36 ms². Stratification of patients according to FC CHF showed an increase in parasympathetic tone: RMSSD was 26.67 ms for FC I and 43.69 ms for FC III; HF was 254.67 ms² for FC I and 541.23 ms² for FC III. The sympathetic and general tone of the ANS was minimal in patients with FC II CHF. A study of the change of indicators over 5 years did not demonstrate a significant increase in the time domain, and the main indicators of the frequency domain decreased significantly: VLF from (1,882.73 ± 119.48) to (1,603.54 ± 99.22) ms²; HF from (334.34 ± 33.13) to (252.87 ± 17.84) ms², LF from (819.48 ± 94.41) to (647.01 ± 42.50) ms². A decrease in the frequency domain was also observed when comparing the HRV results of survived and deceased patients.

Conclusions. The patients with CRHD had lower values of the ANS tone in comparison with patients with other acquired heart valve disease. The smallest values of the general tone of the ANS and SNS were observed in those studied with CRHD with FC II CHF, and the activity of the PNS was maximum at FC III. After 5 years of follow-up, only the frequency indices of HRV were significantly reduced.

1. Bigger JFleiss JSteinman R. et al. RR variability in healthy, middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction. Circulation. 1995; 7: 1936-43. doi: 10.1161/01.cir.91.7.1936.

2. Alieva A.M., Golouhova E.Z., Pinchuk T.V. Heart rate variability in chronic heart failure (literature review). The Russian Archives of Internal Medicine. 2013; 14(6): 47-52. doi: 10.20514/2226-6704-2013-0-6-47-52 [in Russian].

3. Grassi G. Assessment of sympathetic cardiovascular drive in human hypertension: achievements and perspectives. Hypertension. 2009; 54: 690-697. doi: 10.1161/HYPERTENSIONAHA.108.119883.

4. Singh N., Moneghetti K.J., Christle J.W. et al. Heart Rate Variability: An old metric with new meaning in the era of using mHealth Technologies for Health and Exercise Training Guidance. Part One: Physiology and Methods. Arrhythmia & Electrophysiology Review. 2018;7(3):193-8. doi: 10.15420/aer.2018.27.2.

5. Konradi A.O. Autonomic nervous system in arterial hypertension and heart failure: current understanding of its pathophysiologic role and innovative treatment approaches. Russian Journal of Cardiology. 2013; (4): 52-63. doi: 10.15829/1560-4071-2013-4-52-63 [in Russian].

6. Rydlewska A., Jankowska E., Ponikowska B. et al. Changes in autonomic balance in patients with decompensated chronic heart failure. Clin. Auton. Res. 2011;21(1):47-54. doi: 10.1007/s10286-010-0089-z.

7. Yakushin S.S., Filippov E.V. The main directions of the primary prevention of cardiovascular disease. Nauka molodykh (Eruditio Juvenium) 2014;(4):55-68. [in Russian].

8. Prekina V.I., Samolkina O.G. Analysis of heart rate variability in ischemic stroke, depending on the severity and location of the focus. The Russian Archives of Internal Medicine. 2014;(5):42-6. doi: 10.20514/2226-6704-2014-0-5-42-46 [in Russian].

9. Ziep B.M, Taratukhin E.O. Heart rate variability assessment and its potentional. Russian Journal of Cardiology. 2011; 92(6):69-75. doi: 10.15829/1560-4071-2011-6-102-104 [in Russian].

10. Vasyuk Y.A., Shupenina E.Y., Yuschuk E.N. et al. Heart rate variability in assessment of clinical status, functional conditions and prognosis in heart failure. Rational Pharmacotherapy in Cardiology. 2006;(2):61-6. doi: 10.20996/1819-6446-2006-2-2-61-66 [in Russian].

11. Petrov V.S. Result of 5-year observation for patients with rheumatic heart disease. IP Pavlov Medical Biological Herald. 2015; (3):83-7. doi: 10.17816/pavlovj2015383-87 [in Russian].

12. Guyatt G.H., Sullivan M.J, Thompson PJ. et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Archive of “Canadian Medical Association Journal". 1985; 132(8): 919-23.

13. Sassi R., Cerutti S., Lombardi F. et al. Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. Europace. 2015;17(9):1341-53. doi: 10.1093/europace/euv015.

14. Arslan U., Ozdemir M., Kocaman S.A. et al. Heart rate variability and heart rate turbulence in mild-to-moderate aortic stenosis. Europace. 2008; 10: 1434-41. doi:10.1093/europace/eun251.