Diagnostic and Prognostic Value of Psycho-Autonomic Dysfunction as Factor of Ischemic Heart Failure Progression

Introduction. Coronary arteries disease or, as it still often named, ischemic heart disease is responsible as for premature death in acute conditions (occurrence of acute coronary syndromes) as for premature death caused by progression of chronic heart failure (CHF) of ischemic etiology. The pathophysiological mechanisms that lead to the occurrence and progression of psychosomatic and autonomic disorders (in particular, depression) in patients with CHF coincide with the mechanisms of progression of the syndrome of CHF per se. The solution of this problem lays in adequate primary and secondary prophylaxis of heart function deterioration in patients with coronary arteries disease by taking into account psycho-autonomic disturbances that should be used as markers of increased risk for heart failure decompensation. Aim. To evaluate diagnostic and predictive value of psycho-autonomic dysfunction as factor of CHF progression in patients with coronary arteries disease. Materials and methods. The state of autonomic tonic activity was evaluated by analyzing heart rate variability using the diagnostic complex Fasagraf. Psychosomatic misbalance was estimated by filling the Hospital Anxiety and Depression Scale. The calculation of relative risk was carried out by constructing four-squared tables. Results. The study included 151 patients, divided into 4 groups, depending on the presence of isolated or combined vegetative and psychosomatic disorders. In 3 and 6-month periods, the occurrence of signs of decompensation of heart failure was assessed. The presence of a combined psycho-autonomic imbalance was characterized by a statistically significant increase in relative risk for occurrence of all signs of CHF progression (exception only for hospitalizations) compared with the control group in 3-months period of observation. The presence of isolated tonic hypersympathetic exertion resulted in elevated relative risk of edema progression, increasing in body weight due to congestion, for dyspnea progression and NYA class worsening. The presence of isolated psychosomatic imbalances led to a statistically significantly greater relative risk for the progression of edema and the stage of CHF and for progression of shortness of breathing with an increase in CHF NYHA class. The presence of combined psycho-autonomic misbalance during the 6-month period of observation resulted in statistically significant increased relative risk for all parameters of CHF progression, even with the slight increase of it compared to the relative risk in the 3-months period. In a group with solid psychosomatic disorders, the relative risk did not have statistically significant differences compared to the control group. In the group of patients with solid tonic sympathetic exertion tone the relative risk was higher for progression of shortness of breath and CHF NYHA class, edema and CHF stage worsening and for the increasing needs for more aggressive therapeutic tactic. Conclusions. The presence of combined psycho-autonomic disorders or tonic isolated hypersympathetic state causes an increased risk of CHF progression in 3- and 6-months periods. The presence of isolated psychosomatic disorders is characterized by a decrease in the relative risk of progression of dyspnea, edematous syndrome, NYHA functional class and the stage of heart failure during 6-months follow-up period due to regular aerobic exercises and optimal pharmacological treatment.