Diagnostic and Prognostic Value of Psycho-Autonomic Dysfunction as Factor of Ischemic Heart Failure Progression

Abstract

Introduction. Cardiovascular diseases are the main cause of premature death in the structure of overall mortality in Ukraine. Coronary arteries disease (CAD) or, as it still usually named, ischemic heart disease is responsible as for the premature death in acute conditions (occurrence of acute coronary syndromes) as for premature death caused by progression of chronic heart failure (CHF). CHF reduces quality of life, provoking physical disability and mental disturbances (for example, depression and/or anxiety), requiring repetitive hospitalizations and permanent out-of-hospital medical care and so formatting needs in high financial expenses. The solution of this problem lays in adequate primary and secondary prophylaxis of heart function deterioration in patients with CAD by taking into account psycho-autonomic disturbances as markers of increased risk for CHF decompensating.The pathophysiological mechanisms that lead to the occurrence and progression of psychosomatic disorders (in particular, depression) in patients with CHF coincide with the mechanisms of progression of the CHF syndrome per se. It's reasonable to classify them into somatic components (neuro-humoral systems deregulation, immune system dysfunction, systemic inflammation, cytokines toxicity, etc.), behavioral factors (semi-attitude to own health, level of education, social atmosphere) and mechanisms of genetic predisposition [4,5].Several studies showed that the prevalence of depressive disorders among patients with CHF is in range of 14.0-60.0 % [3,6]. In the Heart Failure Adherence and Retention Trial (HART) depression was detected in one third of patients from the total number of participants; its presence was associated with lack of motivation to follow the recommendations of CHF treatment [8]. Also, psychosomatic disturbances are independent contributions to reducing quality of life [2,7,11]. It is important to note that the high prevalence of symptoms of depression was found not only among patients with clear clinical symptoms of