Analysis of the dynamics of the daily variability of the sinus rhythm according to Holter monitoring to assess the effectiveness of treatment of patients with pulmonary hypertension

Purpose: search for criteria for assessing the relationship between the dynamics of the patient’s condition with pulmonary hypertension according to clinical and instrumental examination with the dynamics of the daily variability of his sinus rhythm.

Material and methods. The study included 25 patients with idiopathic pulmonary hypertension (IPH) and 25 patients with chronic thromboembolic pulmonary hypertension (CTPH), who were examined twice at two different hospitalizations: before treatment and after 6–18 months to assess the effectiveness of treatment (50 pairs of examinations). In all examinations, the daily HRV was evaluated according to the Holter ECG data. The functional state was determined comprehensively taking into account the FCLH and the distance covered in the 6-minute walk test. In all patients, the right atrium area (RAA) was determined according to EchoCG data. In 15 out of 50 patients, catheterization of the right parts of the heart (CRPH) was performed during two examinations with determination of pressure in the right atrium (PRA), in the right ventricle, in the pulmonary artery and jamming pressure in the pulmonary artery, as well as oximetry with determination of oxygen saturation of mixed venous blood (SvO2) and cardiac index (CI).The parameters of the daily HRV were determined using a modifi cation of the VSRA-SSR method, taking into account the presence of double fractures (DFR) on the rhythmogram. The dynamics of the parameters of the daily HRV were compared with the dynamics of the functional state, ARA, and also (in 15 cases) — with the dynamics of the average PRA (aPRA), SI and SvO2.

Results 1. The connection between the dynamics of the results of a comprehensive assessment of the functional state of patients with PH and the dynamics of the parameters of their daily HRV is traced. A reflection of this is both a large percentage of cases with unidirectional dynamics of the functional state and HRV, and a small number of cases with multidirectional dynamics. These trends are especially evident in the treatment of patients with IPH.

2. There is a high percentage of coincidences of HRV dynamics and right atrium area (RAA) according to EchoCG data, and this percentage is the highest (with a small number of cases with multidirectional dynamics) in the CTPH group.
3. In most cases, CRPH revealed the correspondence of HRV dynamics to the dynamics of oxygen saturation of SvO2 and SI.

Conclusion. HRV analysis over long periods of time in patients with hypertension can be used not only to assess the functional state of the patient, but also to assess the dynamics of the functional state of the patient, reflecting the effectiveness of the treatment.

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