HEART RATE VARIABILITY IN PATIENTS WITH PREVIOUS Q-WAVE MYOCARDIAL INFARCTION IN DIFFERENT TREATMENT SCHEMES IN EARLY POSTINFARCTION PERIOD

Aim. To evaluate influence of various drug combinations on heart rate variability (HRV) in patients with previous Q-wave myocardial infarction (Q-MI) in outpatient period of rehabilitation.

Material and methods. A total of 316 patients with previous Q-MI were randomized into three groups. Patients of the control group (n=103) received standard therapy (acetylsalicylic acid, enalapril, metoprolol, simvastatin) during 2 years after discharge from the hospital. Patients of the first studied group (n=107) were additionally treated with trimetazidine, and patients of the second group (n=106) received combined therapy with ramipril, carvedilol and trimetazidine. HRV parameters (derived from ECG 5-minute recording) were registered at the beginning of the study, 6 and 24 months after the beginning of the study.

Results. HRV parameters improvement was more significant in the second group compared to the first and to control groups. In the second group LF increased from 223.8±56.2 to 734±90.9 мs2 (p<0.001), in the first group – from 217.8±54.3 to 713±88.1 мs2, and in control group – from 225.4±49.0 to 589±72.0 мs2. HF increase was also more significant in the second group: from 189.5±54.4 to 801±97.5 мs2 (p<0.001) compared to the first and to control groups: from 176.6±47.3 to 579±91.2 мs2 and from 180.9±50.4 to 487±83.4 мs2, respectively. SDNN rose from 27.8±3.2 to 52.4±4.4 ms (p<0.05) in the second group, from 27.4±2.7 to 41.2±3.8 ms in control group, and from 26.7±3.0 to 46.5±4.0 ms in the first group. RRNN increased from 664.5±99.0 to 833±98.7 ms (p<0.05) in the second group, from 676.2±85.3 to 793±87.6 ms in control group, and from 658.1±97.2 to 826±92.8 ms in the first group.

Conclusion. Two-year treatment with enalapril and metoprolol as a part of standard therapy improves HRV parameters of Q-MI patients. Addition of trimetazidine to this combination leads to even more significant improvement of HRV parameters in postinfarction period. The most significant effect on the reduction of sympathetic nervous system activity, increase in parasympathetic nervous system activity as well as improvement of HRV parameters was observed in therapy with combination of trimetazidine, ramipril and carvedilol.

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