Original Investigation 11Autonomic control in CVS can be assessed by HRV analysis.Various time domain and frequency domain indices are usually used for this purpose (2). The physiological explanation of these indices is known (2,19,20). These indices can assess cardiac autonomic regulation but not peripheral blood flow. In our previous papers, we have proposed an original method for the assessment of cardiovascular autonomic control based on synchronization between the 0.1-Hz rhythms in heart rate (HR) and photoplethysmogram (PPG) (21). The quality of 0.1-Hz rhythms synchronization was found to be higher in healthy subjects than in patients with cardiovascular disease (22). From a physiological viewpoint, the synchronization of 0.1-Hz rhythms is the result of adequate functional interaction of CVS parts (heart and peripheral vessels). The clinical importance of this diagnostic method is shown for patients with prior myocardial infarction, patients with acute coronary syndrome, and hypertensive patients (3,23). The physiological explanation of 0.1-Hz rhythms in PPG is a debatable point. An opto-physiological model of a finger in conjunction with a near-infrared reflectance PPG device has been proposed (24). It was shown that both oscillations in the microcirculatory bed and blood filling of digital arteries make a substantial contribution to the PPG signal. Therefore, 0.1-Hz oscillations in PPG may be associated directly with baroreceptor regulation of blood pressure (BP). At the same time, a number of authors assume that 0.1-Hz oscillations in blood microcirculation are not associated with autonomic regulation (25)(26)(27)(28). To avoid confusion, we do not interpret the origin of 0.1-Hz oscillations in PPG in the present paper. Thus, the features of cardiovascular autonomic control in women before and after menopause are not fully understood. Controversial results concerning this problem have been reported. The aim of the present study cross-sectional study is to assess the features of autonomic control of CVS in pre-and postmenopausal women. Material and Methods PatientsThe study was approved by the ethics committee of the Saratov Research Institute of Cardiology in Saratov, Russia (no. 24, Sept. 12, 2013) and informed consent was obtained from all participants. Our cross-sectional study included 185 postmenopausal women aged 59.3±8.5 years (mean±SD) and 104 premenopausal women aged 45.1±5.8 years. Both groups were investigated and treated, if necessary, in the clinic of Saratov State Medical University (Saratov, Russia). Clinical characteristics (cardiovascular, gynecological, etc.) were assessed in all women. We assessed the level of the following sex hormones: estradiol, follicle-stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEAS), and testosterone. Only patients aged between 35 and 70 years were enrolled in our study. Women with CVD were not on beta-blockers or calcium channel blockers during the 7 days before the start of the study.Patients were not included in our study if they ...

Objective The aim of this study was to assess the dynamical interaction between the cardiovascular autonomic control and sex hormones in perimenopausal women under menopausal hormone therapy (MHT).Patients and methods Seventy women (age: 51.6 ± 2.1 years) were treated with MHT. Standard time and frequency domain measures of heart rate variability (HRV) and index S of synchronization between the slow oscillations in HRV and photoplethysmographic waveform variability were studied during a 6-week treatment with MHT. We assessed also the dynamics of the following sex hormones: estradiol, follicle-stimulating hormone, dehydroepiandrosterone sulfate, and testosterone.Results MHT increased estradiol and decreased folliclestimulating hormone. Hot flashes and index S were significantly decreased under MHT (P < 0.05). Other autonomic indices were not significantly changed (P > 0.05). Changes of index S did not correlate with changes of sex hormones and hot flushes (P > 0.05). ConclusionThe obtained results may indicate the independence of heart autonomic control (assessed by HRV measures) from women's hormonal status. However, any changes in sex hormones contribute to changes in the systemic control of circulation, which is assessed by index S.

Background and Aims There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. Methods A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.

; Караваев Анатолий Сергеевич, канд. физ.-мат. наук, cт. научн. сотр., доцент; Прохоров Михаил Дмитриевич, доктор физ.-мат. наук, вед. научн. сотр.; Бобылева Ирина Владимировна, аспирант; Гриднев Владимир Иванович, доктор мед. наук, руководитель Центра продвижения новых кардиологических информационных технологий; Киричук Вячеслав Федорович, доктор мед. наук, профессор, заслуженный деятель науки РФ, заведующий кафедрой; Рогожина Ирина Евгеньевна, доктор мед. наук, профессор, заведующий кафедрой Цель. Изучение особенностей вегетативной регуляции сердечно-сосудистой системы у женщин в перименопаузе с учетом различий их клинического статуса. Материал и методы. В одномоментное исследование были включены 185 женщин в постменопаузе (59,3 ± 8,5 года) и 104 женщины с сохраненным менструальным циклом (45,1 ± 5,8 года). Был оценен общий клинический статус, наличие приливов, тяжесть климактерического синдрома (индекс Купермана), уровни половых гормонов (эстрадиол, фолликулостимулирующий гормон, дегидроэпиандростерон сульфат и тестостерон), показатели вариабельности сердечного ритма (средняя частота сердечных сокращений, SDNN, RMSSD, PNN50, коэффициент вариации, а также спектральные мощности низко-и высокочастотного спектральных диапазонов, выраженные в абсолютных единицах и в процентах от общей мощности спектра) и синхронизованности низкочастотных (около 0,1 Гц) колебаний в вариабельности сердечного ритма и фотоплетизмограмме (показатель S). Результаты. Не было выявлено статистически значимых различий между группами женщин с сохраненным менструальным циклом и в менопаузе по большинству показателей вегетативной регуляции кровообращения (кроме среднего уровня частоты сердечных сокращений). Большинство оцененных показателей вариабельности сердечного ритма коррелировали (коэффициент корреляции r составлял 0,17-0,24) со сроком естественной менопаузы. С давностью наступления хирургической менопаузы коррелировал только показатель синхронизованности колебаний с частотой около 0,1 Гц-S (r =-0,41, р = 0,039). Также выявлены статистически (но не клинически) значимые корреляции между некоторыми показателями вегетативной регуляции и уровнями половых гормонов. Заключение. Не было выявлено клинически значимых ассоциаций показателей вегетативной регуляции сердечно-сосудистой системы и характеристик менопаузального статуса женщины (уровни половых гормонов, приливы, индекс Купермана). Однако были показаны статистически (но

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