SMALL ANOMALIES OF HEART DEVELOPMENT: PSYCHOPHYSIOLOGICAL ASPECTS OF THE PROBLEM
Connective tissue dysplasia, which includes small anomalies of the heart development, has currently become increasingly important in the structure of cardiovascular pathology. First of all, it is caused by the fact that connective tissue takes part in the heart skeleton formation practically at all stages of ontogenesis. On the one hand, when the detection of small cardiac anomalies is incidental and is not accompanied by any other signs of connective tissue dysplasia and/or deviations of cardiac morphology and function, we can refer them to a variant of normal. On the other hand, significant small anomalies of the heart can cause a variety of complications or aggravate other pathological conditions or diseases over the years. Idiopathic mitral valve prolapse is the most common among small heart anomalies. According to some authors, the most frequent and severe among complications of mitral valve prolapse is progression of mitral regurgitation. Progression of mitral regurgitation is variable and, in part, is determined by the size of mitral ring. By the time mitral regurgitation becomes severe, enough time has passed for eccentric cardiac hypertrophy to develop. As a result, an increase in the left ventricular end-diastolic volume is compensatory because it increases the total stroke volume, which allows the subsequent cardiac output to be maintained at an adequate level. Not only issues related to the nature of the relationship between mitral regurgitation and left ventricular systolic function indices and the risk of cardiovascular accidents in persons with small heart anomalies, but also views on personality response features, including their correlations with physiological parameters in this population remain controversial at present. The aim of our study was to assess the psychophysiological features of persons with small heart anomalies of varying degrees of severity in their relationship with left ventricular systolic function indices and the degree of mitral regurgitation (if present) to optimize the secondary prevention of cardiovascular complications in this population. During the study, 128 clinically healthy male and female patients (mean age 20.16±2.42 years) with small heart anomalies of different severity and assessed by Doppler echocardiography were examined; 62 of them formed Group I with minimal small heart anomalies and 66 with moderate small heart anomalies formed Group II; 40 virtually healthy subjects without signs of small heart anomalies formed a control group. The groups were comparable by age and sex. To analyze psychophysiological features of persons with small heart anomalies of various degrees of severity we used methods of the Abbreviated Multifactor Personality Inventory; E. Heim test (to assess stress coping behavior formation with differentiation in spheres - cognitive, emotional and behavioral); Thoront alexithymic scale; C. Spielberger questionnaires modified by J. Hanin (to determine levels of personal and reactive anxiety) and S. Subbotin (for assessment of stress resistance); psychogeometric test as a projective technique. It was shown that control group persons (clinically healthy without signs of small cardiac abnormalities) were characterized by sociability, purposefulness, self-confidence, high level of responsibility. Being in difficult situations, they maintained self-control and optimism, cooperated with significant people. All central hemodynamic parameters of the control group, characterizing systolic function of the left ventricle, were within the physiological norm. Group I subjects (with minimal degree of small anomalies of the heart) were characterized by optimism, absence of difficulties in interpersonal interactions, firmness in achieving the set goal, adequate stability in stressful situations, moderate levels of both reactive and dispositional anxiety; significant prevalence of constructive forms in cognitive, emotional and behavioral coping-spheres (p<0,05). At the same time there was a tendency to emerge contradictory intrapersonal tendencies: communicativeness and non-conflictuality, on the one hand, and masked aggression in case of insufficient attention to them or refutation of their opinions, on the other hand. Group II individuals (with moderate small cardiac abnormalities) were bearers of a medium degree of stress tolerance and contradictory psychological tendencies: sociability, persistence in achieving goals, benevolent attitude towards near and far surroundings, and, along with that - episodes of solitude, withdrawal, mistrustfulness and suspiciousness, ignoring public opinion; increased desire for love and recognition - but, at the same time, displays of aggression in cases when they were denied care and attention It was shown that in clinically healthy individuals with small cardiac abnormalities, the levels of anxiety and alexithymia were higher and the levels of stress resistance and adaptability in all coping spheres were lower the more pronounced the manifestations of connective tissue cardiac dysplasia, and this was particularly evident with mitral regurgitation: the above psychological features were sharpened in both groups. Besides, linear and volumetric parameters of left ventricular systolic function were significantly higher in less adaptive and stress-resistant, more alexithymic and anxious individuals with mitral regurgitation, and parameters of global left ventricular contractility were statistically significantly lower. The obtained data should be taken into account to increase the efficiency of personalized prevention of cardiovascular complications in carriers of small heart anomalies.