[Automatic regulation and central hemodynamics in patients with postinfarct cardiosclerosis and heart failure]

The study was undertaken to examine the specific features of autonomic regulation and the parameters of central hemodynamics in patients with postinfarct cardiosclerosis (PICS) and circulatory insufficiency who had different types of left ventricular remodelling (LVR). Thirty-two patients with PICS and heart failure (HF) were examined. The autonomic status was studied, by analyzing cardiac rhythm variability (CRV) from 5-min resting cardiointervalograms and by the cardiovascular tests described by D. Y. Ewing; integral rheography was also performed. The patients were divided into 2 groups according to the type of LVR. Patients with PICS + HF and concentric LVR were found to have a more balanced autonomic circulatory regulation and a hemodynamic type that was more energetically efficient for the myocardium. Those with PICS + HF and eccentric LVR had a hemodynamic type that was less efficient for the myocardium, which was accompanied by the enhanced activity of the sympathetic nervous system (SNS) even at resting. Patients with PICS + HF, particularly in the presence of the latter's higher functional class and eccentric LVR, seemed to have desensitized adrenoceptors and impaired baroreflex activity, as appeared as no rise in peripheral vascular resistance with the enhanced sympathetic activity. The findings support the expediency of using beta-adrenoblockers in HF in patients with PICS, particularly with eccentric LVR. Analysis of cardiac rhythm variability is sufficiently informative in evaluating autonomic regulation and autonomic balance, SNS tone in particular, in patients with HF.