[Ischemic cardiomyopathy. Parameters of the autonomic tone].

BACKGROUND

Despite significant improvements with respect to medical and interventional therapies, late mortality after myocardial infarction remains high. Therefore, the identification of high-risk patients who benefit from an intensified treatment approach is of great clinical interest.

METHODS AND RESULTS

Experimental and clinical studies have shown that dysfunction of the cardiac autonomic innervation is associated with a poor prognosis in patients with ischemic cardiomyopathy. Clinical routine allows for noninvasive assessment of the cardiac autonomic innervation by means of ECG analysis. Parameters of heart rate variability reflect sympathetic and parasympathetic regulatory processes at the sinus node level. Recently, low frequency oscillatory modulations of the T-wave, which reflect sympathetic effects at the level of ventricular myocardium, have been identified.

CONCLUSION

To optimize risk assessment, different parameters of the autonomic function can be combined. A large number of studies have proven the prognostic value of parameters of the autonomic nervous system. However, randomized controlled trials are needed to show whether patients with ischemic cardiomyopathy and autonomic dysfunction benefit from specific therapeutic interventions, i.e., intensified monitoring or ICD implantation.