The scientific novelty of the study A large number of reports have demonstrated that depressed heart rate variability after myocardial infarction (MI), left ventricular dysfunction and arrhythmias are powerful predictors of mortality. Nevertheless there is a lack of detailed assessment of heart rate variability in the acute period of MI, especially during the first 24 hours, from long-term (24-h) recordings, and the value of different parameters of heart rate variability in predicting dangerous complications of MI was not fully evaluated. The indications of complex and constant monitoring of heart rate variability, left ventricular function, arrhythmias in acute MI are not based on scientific studies as well as their value in predicting the effect of different methods of management, course and outcomes of critical cardiac conditions. Thus, the current study differs from all the earlier studies in that we assessed heart rate variability in the very early period of myocardial infarction (the first and the third day) using long time recordings (24 h), both – time-domain and frequency-domain –methods, and evaluated its changes in relation to arrhythmias and left ventricular function, using not only conventional 2D-echocardiography but also left ventricular long axis function assessment by M-mode and tissue Doppler imaging. The aim of the study The aim of the study was to determine the association between heart rate variability, cardiac arrhythmias and left ventricular... [to full text]

Disertacijoje iškelta sergančiųjų ūminiu miokardo infarktu ir cukriniu diabetu asmenų nepalankios ligos eigos problema bei apžvelgos galimybės prognozuoti tokių asmenų ligos baigtis.Darbo uždaviniais buvo: 1) įvertinti širdies ritmo variabilumo ir hemodinamikos žymenis sergantiesiems ūminiu miokardo infarktu bei cukriniu diabetu priklausomai nuo ligos eigos ir baigčių, palyginti juos su nesergančiųjų cukrininu diabetu atitinkamais žymenimis; 2) nustatyti sergančiųjų miokardo infarktu prognozinę širdies ritmo variabilumo ir hemodinamikos žymenų vertę mirties, skilvelinės aritmijos, grįžtamosios išemijos išsivystymui ar jungtinei vertinamajai baigčiai stacionare; 3) nustatyti prognozinę širdies ritmo variabilumo ir hemodinamikos žymenų vertę per 1 metus ir per 5 metus po persirgto miokardo infarkto įvykusiems: mirčiai dėl bet kokios ir dėl širdinės priežasties, pakartotino miokardo infarkto išsivystymui, neplanuotos širdies revaskuliarizacijos procedūros atlikimui, nekomplikuotos išeminės širdies ligos eigos buvimui; 4) nustatyti ar prognozinė širdies ritmo variabilumo ir hemodinamikos žymenų vertė analizuojamoms baigtims skiriasi tiriamųjų grupėse: a) cukriniu diabetu sergančiųjų asmenų, b) cukriniu diabetu nesergančiųjų asmenų; 5) gautų prognozinių modelių diskriminuojančias savybes palyginti tarpusavyje ir su pripažintais ūminio miokardo infarkto rizikos vertinimo kriterijais (kairiojo skilvelio išstūmio frakcija, GRACE ir TIMI rizikos vertinimo skalėmis). / Unfavourable outcomes of the diabetic patients with acute myocardial infarction were analysed in the dissertation and possibilities to predict the course of the disease was reviewed. The objectives of the study were: 1) to evaluate the measures of heart rate variability and impedance cardiography for the patients with acute myocardial infarction, and their alterations in reliance on the different outcomes, according to the patients’ status of diabetes mellitus; 2) to determine prognostic value of combined assessment of heart rate variability and impedance cardiographymeasures for in-hospital outcomes of myocardial infarction: in-hospital mortality, ventricular arrhythmia, recurrent ischemia and complicated in-hospital course; 3) to determine prognostic value of combined assessment of heart rate variability and impedance cardiography measures for long-term (1 and 5 years) outcomes after myocardial infarction: mortality (both all-cause death and cardiac death), ischemic complications (recurrent non-fatal myocardial infarction and need for revascularization procedures) and uncomplicated long-term course; 4) to assess whether prognostic value of combined heart rate variability and hemodynamic measures differs in separate patient groups: diabetic or non-diabetic; 5) to compare the discriminative power of the obtained prognostic models and widely recognized risk markers, such as ejection fraction of the left ventricle, GRACE and TIMI scores.