PSI - Issue 40

V. Mironov et al. / Procedia Structural Integrity 40 (2022) 296–306

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V. Mironov at al. / Structural Integrity Procedia 00 (2022) 000 – 000

cardioarrhythmias and RCG symptoms of lethal outcome. Thus, the evaluation of the peripheral autonomic regulation of the sinus heart node has prospects for cardiosurgical management of the CABGS. 123 male patients with coronary artery disease, unstable angina pectoris and chronic heart failure (CHF) of 3 to 4 functional class (FC) were assessed by CABGS. The subjects’ mean age was 64 . 7±5 .44 years. All subjects were examined by standard cardiological methods (ECG, ECHOCG, HM, CAG, laboratory examines, and others) and RCG with HRV analysis before, during, and after CABGS. CABGS on the open heart and artificial circulation caused worsening in all patients during the early postoperative period, and there was no decrease in HRV-indices (Table 1). The spectral correlation changed due to increased spectral shares of the humoral-metabolic influence in SN and fast decrease in the indices of autonomic regulation (Table 1). The humoral-metabolic regulation is slow and inadequate and it predominates in the simplest creatures. HRV stabilization as a syndrome of autonomic cardioneuropathy (ACN) with low sympathetic and parasympathetic control is a marker of a high risk of complications during and after surgery Brener at al. (2008), Kazemi at al. (2011), Ksela at al. (2009), Laitio at al. (2007), Carney at al. (2005), Mironova (2000, 2009).

Table 1. HRV indices before (n-123) and after operation (n-123) at the CABGS.

HRV indices (M   ) in seconds (s) and spectral %. Criterions Z and p HRV – indices before CABS HRV – indices after pre medication

RR, s average quadratic deviation of RR- intervals

SDNN, s average quadratic deviation of all HRV waves

σl, s average quadratic deviation of humoral HRV waves

σm , s average quadratic deviation of sympathetic HRV waves

VLF, % spectral share of humoral metabolic HRV waves

LF, % spectral share of sympathetic HRV waves

HF, % spectral share of parasympath etic HRV waves

σs, s average quadratic deviation of parasympathe tic HRV waves

0. 984± 0.144

0. 024± 0.009

0. 018± 0.008

0. 011± 0.005

0. 011± 0.008

56. 39± 14.9

17. 84± 10.83

25. 76± 12.53

0. 522± 0.031

0. 011± 0.002

0. 002± 0.001

0. 001± 0.0012

0. 002± 0.001

68. 8± 8.42

15. 23± 6.11

15. 7± 4.78

Z* p

34.7 p<0.0001

6.5 p<0.01

1.45 p>0.05

4.01 p<0.05

12.8 p<0.001

7.892 p<0.01

2.1 p<0.05

6.89 p<0.01

The stabilization of HRV without any RCG fluctuations is the most dangerous pattern of RCG changes. The RCG changes may be sufficient to suggest ACN occurrence. ACN is referred to the loss of the autonomic rapid heart rate control, a significantly decreased adaptation to changing living conditions and activity. Usually such syndrome occurs in the most severely ill patients. ACN has been found in 56 subjects. One of them died on the 4th day after surgery. ACN patients were compared with 67 persons without ACN (Table 2). The HRV indices presented in pts with ACN were significantly worse than those in persons without ACN. Baseline RCG data are presented in Fig. 2. Thus, HRV stabilization is a predictor of complications and death during and after heart surgery intervention. Figure 2 shows significant HRV stabilization on the background of the tachycardia (120/min and >) and the absence of any reactions to stimuli in tests after CABGS. The predominant share in the regulation of the sinoatrial heart node is the humoral-metabolic factor (VLF%), which is nonsufficient, very slow, and inadequate. In the end, Ph (RCGs 1 and 2) registered signs of the sinoatrial blockade of 2 types, 3 degrees. In Ashner test (RCG 3), there are 6 episodes of the heart rhythm migration. The pt had a very heavy status and on the 4th day after operation he died. Monitor records demonstrated specific wave structure patterns at each CABGS stage (Table 3). Every stage had different values of HRV indices. After premedication and intubation narcosis, all wave structures had lowest fluctuations.