Русский
Peculiarities of cardiac remodeling in patients with ischemic heart disease after coronary artery bypass grafting, with various recovery duration at the outpatient rehabilitation stage
DOI: https://dx.doi.org/10.18565/therapy.2024.10.60-70
Styazhkina Yu.A., Grishina I.F., Poletaeva N.B., Peretolchina T.F.
Ural State Medical University of the Ministry of Healthcare of Russia, Yekaterinburg
The aim: to analyze the peculiarities of EchoCG in CAD patients after CABG with different duration of recovery at the outpatient rehabilitation stage.
Material and methods. The study included 100 male patients with CAD after CABG operation. All participants were retrospectively divided into two groups in accordance with the duration of after-CABG recovery period. Group 1 included 58 patients who returned to work within 4 months after the intervention, group 2 included 42 patients who required an extension of rehabilitation for more than 4 months after CABG performing. All patients underwent EchoCG in 1 and 4 months after CABG.
Results. In patients with protracted after-CABG recovery, the left atrium and left ventricle (LV) sphericity index values were higher than the same in the early recovery group (p = 0.01) and the control group (p = 0.01). By the 4th month of observation, LV geometry abnormalities (p = 0.28) persisted in patients in Group 2. The left ventricular myocardial mass index(LVMI) significantly exceeded similar values in comparison with the control group (p = 0.01) and with patients with rapid recovery by the 4th month of observation (p = 0.01). End-diastolic and end-systolic volume indexes (p = 0.01) demonstrated an increase by the 4th month of observation, while a decrease in the LV ejection fraction was also noted (p = 0.01). High mean values of end-diastolic LV wall stress were recorded in patients with coronary artery disease and protracted recovery period throughout the entire observation period (p = 0.01). By means of stepwise regression analysis, predictors of unfavorable type of remodeling were identified – older patient age, history of myocardial infarction (post-infarction cardiosclerosis), arterial hypertension, high body mass index (BMI) and smoker’s index (SI).
Conclusion. In patients with a protracted recovery period, LV geometry abnormalities, systolic and diastolic dysfunction are persisting throughout the all rehabilitation period, indicating a breakdown of intracardiac hemodynamic compensation mechanisms. Fixed correlations between echocardiography and patient’s age, history of porst-infarction cardiosclerosis, hypertension, BMI, and SI may indicate a potential contribution to the protracted course of recovery in such patients, which dictates the need to take them into account during rehabilitation process.
Literature
1. Бокерия Л.А., Аронов Д.М. Российские клинические рекомендации. Коронарное шунтирование больных ишемической болезнью сердца: реабилитация и вторичная профилактика. CardioСоматика. 2016; 7(3–4): 5–71. (Bokeriya L.A., Aronov D.M. Russian clinical guidelines. Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. CardioSomatika = Cardiosomatics. 2016; 7(3–4): 5–71 (In Russ.)). EDN: YNTENB. 2. Лубинская Е.И., Николаева О.Б., Демченко Е.А. Сопоставление клинической и социальной эффективности кардиореабилитации больных, перенесших коронарное шунтирование. Вестник Российской военно-медицинской академии. 2012; 1(37): 218–223. (Lubinskaya E.I., Nikolaeva O.B., Demchenko E.A. Clinical and social effectiveness of comprehensive cardiac rehabilitation program in patient after coronary artery bypass surgery. Vestnik Rossiyskoy voenno-meditsinskoy akademii = Bulletin of the Russian Military Medical Academy. 2012; 1(37): 218–223 (In Russ.)). EDN: OXMTBZ. 3. Arruda A.M., McCully R.B., Oh J.K. et al. Prognostic value of exercise echocardiography in patients after coronary artery bypass surgery. Am J Cardiol. 2001; 87(9): 1069–73. https://doi.org/.1016/s0002-9149(01)01463-1. PMID: 11348604. 4. Metkus T.S., Suarez-Pierre A., Crawford T.C. et al. Diastolic dysfunction is common and predicts outcome after cardiac surgery. J Cardiothorac Surg. 2018; 13(1): 67. https://doi.org/10.1186/s13019-018-0744-3. PMID: 29903030. PMCID: PMC6003153. 5. Lang М.R., Badano P.L., MorAvi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14. https://doi.org/10.1016/j.echo.2014.10.003. PMID: 25559473. 6. Du Bois D., Du Bois E.F. A formula to estimate the approximate surface area if height and weight be known. Nutrition. 1989; 5(5): 303–13. PMID: 2520314. 7. Devereux R.B., Alonso D.R., Lutas E.M. et al. Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol. 1986; 57(6): 450–58. https://doi.org/10.1016/0002-9149(86)90771-x. PMID: 2936235. 8. Stork T.V., Müller R.M., Piske G.J. et al. Noninvasive measurement of left ventricular filling pressures by means of transmitral pulsed Doppler ultrasound. Am J Cardiol. 1989; 64(10): 655–60. https://doi.org/10.1016/0002-9149(89)90497-9. PMID: 2782257. 9. Терещенко С.Н., Жиров И.В., Насонова С.Н. с соавт. Патофизиология острой сердечной недостаточности. Что нового? Российский кардиологический журнал. 2016; 21(9): 52–64. (Tereshchenko S.N., Zhirov I.V., Nasonova S.N. et al. Pathophysiology of acute heart failure. What’s new? Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2016; 21(9): 52–64 (In Russ.)). https://doi.org/10.15829/1560-4071-2016-9-52-64. EDN: WJHBSR. 10. Salavatian S., Spinelli J.C., Schaefer J.A., Libbus I. et al. Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation. Front Neurosci. 2024; 18: 1377171. https://doi.org/10.3389/fnins.2024.1377171. PMID: 38482139. PMCID: PMC10933133. 11. Патофизиология сердечно-сосудистой системы. Под ред. Л.С. Лилли; пер. с англ. под ред. Е.Л. Бокерия. 5-е изд., перераб. и доп. М.: Лаборатория знаний. 2023; 712 с. (Pathophysiology of heart disease. An introduction to cardiovascular medicine. Ed. by Lilly L.S.; translation from English edited by Bokeriya E.L. 5th edition, revised and enlarged. Moscow: Laboratoriya znaniy = Laboratory of Knowledge. 2023; 712 pp. (In Russ.)). ISBN: 978-5-00101-327-3. 12. Jiang H., Fang T., Cheng Z. Mechanism of heart failure after myocardial infarction. J Int Med Res. 2023; 51(10): 3000605231202573. https://doi.org/10.1177/03000605231202573. PMID: 37818767. PMCID: PMC10566288. 13. Самадов Ш.Х., Кокшенева И.В. Механизмы повреждения миокарда при операциях коронарного шунтирования. Кардиоваскулярная терапия и профилактика. 2010; 9(8): 75–80. (Samadov Sh.Kh., Koksheneva I.V. Myocardial damage mechanisms in coronary artery bypass surgery (literature review). Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2010; 9(8): 75–80 (In Russ.)). EDN: NCXYCF. 14. Kloner R.A. Stunned and hibernating myocardium: Where are we nearly 4 decades later? J Am Heart Assoc. 2020; 9(3): e015502. https://doi.org/10.1161/JAHA.119.015502. PMID: 32013699. PMCID: PMC7033879.
About the Autors
Yulia A. Styazhkina, MD, assistant at the Department of outpatient therapy, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Yekaterinburg, 3 Repina St.
E-mail: nadeyulya@yandex.ru
ORCID: https://orcid.org/0009-0008-6259-4592
Irina F. Grishina, MD, Dr. Sci. (Medicine), professor, head of the Department of outpatient therapy, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Yekaterinburg, 3 Repina St.
E-mail: grishif@mail.ru
ORCID: https://orcid.org/0009-0005-8643-1825
Nina B. Poletaeva, MD, PhD (Medicine), associate professor of the Department of outpatient therapy, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Yekaterinburg, 3 Repina St.
E-mail: ninanova@mail.ru
ORCID: https://orcid.org/0000-0001-7674-2893
Tatyana F. Peretolchina, MD, Dr. Sci. (Medicine), professor, head of the Department of preventive and family medicine, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Yekaterinburg, 3 Repina St.
E-mail: estvmed2011@mail.ru
ORCID: https://orcid.org/0009-0001-5289-9711
Similar Articles
