POSSIBILITIES OF USING THE PHASEGRAPHY METHOD AS A MARKER OF ISCHEMIC CHANGES IN THE MYOCARDIA IN CARDIAC SURGICAL PATIENTS WHO HAVE UNDERGONE ARTOCORONARY BYPASS WITH THE USE OF ARTIFICIAL CIRCULATION

Abstract

Introduction. Heart rate variability is a non-invasive method used to assess the modulation of the autonomic nervous system in the sinus node of the heart, which reflects the variability of the durations of successive R-R intervals on electrocardiograms. Phasagraphy is an innovative method of cardiology that allows to estimate the indicator of βT - symmetry of the T wave, which reflects the period of early repolarization of the heart. The aim. To expand the diagnostic criteria for perioperative hemodynamic disorders in patients who underwent surgery - coronary artery bypass grafting with cardiopulmonary bypass. Materials and methods. 500 patients were operated on at the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department. All underwent coronary artery bypass graft surgery with cardiopulmonary bypass. 80 patients were selected and examined by Fazagraf®, βT and LF / HF were analyzed. The main group included 35 patients who developed hemodynamic disorders in the early postoperative period. Inotropic support with dobutamine and metabolic support with a combination of levocarnitine and arginine were used to stabilize hemodynamics. The control group included 45 patients who did not have hemodynamic disorders. Results. At the stages of this study, the stability of LF/HF values was recorded, which indicates the adequacy of perioperative anesthesia and analgesia. The LF/HF in the preoperative period of the main group differed from the control group. After stabilization of hemodynamics LF/HF reached reference values. In order to correct acute left ventricular failure with dobutamine and the combination of levocarnitine and arginine in the main group of patients, the βT index shifted to the zone corresponding to the "health" of the myocardium. Conclusions. The LF/HF value reliably reflects the ratio of sympathetic and parasympathetic parts of the autonomic nervous system. An increase in LF/HF before surgery indicates the risk of hemodynamic disorders after surgery, and its decrease in the postoperative period - to stabilize the patient's condition. βT is associated with clinical data on myocardial status and can be used to determine myocardial health in patients with coronary heart disease. The combination of levocarnitine and arginine has a pronounced metabolic effect on the myocardium, which underwent surgery with cardiopulmonary bypass.

Keywords

• cabg
• acute left ventricular failure
• heart rate variability
• phasagraphy