N.T. Vatutin, N.V. Kalinkina, V.S. Kolesnikov. Autonomic imbalance in patients with stable angina: possible physiological triggers of preconditioning process.

The aim – assessment of influence of adenosine-containing drug on heart rate variability in patients with angina pectoris.

Material and methods. We observed 18 patients (11 men and 7 women, mean age 56±3 years) with II–III functional class stable angina pectoris, being progressive at the time of inclusion into the study. Patients were divided into 2 groups: in the 1st (n=9) we administered standard pharmacological therapy of progressive angina pectoris, in the 2nd (n=9) – in addition to it – adenosine-containing drug for 1 month. The control group consisted of practically healthy people of the same age (n=10). All patients at baseline (day of hospitalization), 1 week after the stabilization of angina pectoris and after 3 months (2 months after stop of adenosine-containing drug) ECG monitoring was performed with the following assessment of the temporal and spectral indices of HRV.

Results. At baseline, SDNN, RMSSD, NN50, triangular index, TP and HF did not differ significantly between the 1st and 2nd groups, but were significantly (Р<0.05) lower than in the control group. SDANN, LF and LF/HF in both groups were higher (Р<0.05) than in the control. During the second survey after the stabilization of angina in the 2nd group, there was a trend to an increase of SDNN, RMSSD and TR and reduce of SDANN (Р<0.1), but the values comparable with the control group, were not achieved. In group 1, this trend was not observed. After 3 months in both clinical groups we observed a significant decrease of SDANN and reduction of LF and LF/HF to values comparable to the control, with no significant differences between groups (Р>0.05). NN50 and triangular index in the 1st and 2nd groups did not change. In group 2, we noted a significant increase in SDNN, RMSSD, HF and TP, while in the 1st group, these did not change.

Conclusions. Adenosine-containing drug improves autonomic regulation of heart during treatment and two months after its abolishment. The positive effect of the drug on autonomic tone is due to the pharmacological preconditioning, which helps to increase the insensitivity of cardiomyocytes to ischemia.

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