CARDIOPROTECTIVE EFFECT OF PHYSICAL REHABILITATION IN PATIENTS WITH ISCHEMIC-ORIGIN DIASTOLIC DYSFUNCTION AFTER PERCUTANEOUS CORONARY INTERVENTION

Aim. To study effect of long-term controlled physical training (CPT) of moderate intensity on diastolic function, depending on the degree of recanalization, in patients with ischemic heart disease (ICD) with left ventricle diastolic dysfunction (DD) who underwent percutaneous coronary intervention (PCI). Material and methods. Patients with ICD (n=60, all males, aged from 49 to 58 years) who had undergone PCI last 3–6 weeks were included into the study. They were randomized into two groups depending on CPT availability in the rehabilitation program. Standard clinical examination, diastolic function assessment, exercise tolerance test were performed at baseline, after 6 and 9 months. Results. The long-term CPT of moderate intensity led to diastolic function improvement in 15.6% of patients after 6 months and 28.1% - in 9 months. Improvement of diastolic function in ICD patients with complete recanalization was observed after 6 months of CPT moderate intensity. Longer period of physical rehabilitation (9 months or more) was required for patients with incomplete recanalization. The improvement of diastolic function without CPT was observed after 6 months in 2 (7.1%) patients with a relaxation type of DD and complete recanalization. Normalization of diastolic function without CPT after 9 months was observed in 10.7% of patients and 3.5% of patients showed DD progression. Conclusion. Inclusion of the long-term CPT of moderate intensity into the rehabilitation program has cardioprotective effect in ICD patients with ischemic DD undergoing PCI.

1. Belardinelli R., Paolini I. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol 2001;37: 1891–1900.

2. Taylor RS, Brown A, Ebrahim S et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116(10):682–92.

3. Baratz S.S., Zakroeva A.G. Diastolic dysfunction of the heart on indicators of transmitral blood flow and flow in the pulmonary veins: discussion of the pathogenesis, terminology and classification. Kardiologiia 1998; (5): 69—76. Russian (Барац С.С., Закроева А.Г. Диастолическая дисфункция сердца по показателям трансмитрального кровотока и потока в легочных венах: дискуссионные вопросы патогенеза, терминологии и классификации. Кардиология 1998; (5): 69—76).

4. Choong C.Y. Left ventricle: diastolic function — its principles and evaluation. In: Weiman A., ed. Principles and practice of echocardiography. Philadelphia: LeaandFebiger; 1994: 17–21.

5. Ageev F.T., OvchinnikovA.G. Diastolic dysfunction as a manifestation of cardiac remodeling. Serdechnaja Nedostatochnost' 2002; 4: 190–195. Russian (Агеев Ф.Т., Овчинников А.Г. Диастолическая дисфункция как проявление ремоделирования сердца. Сердечная Недостаточность 2002; 4: 190–195).

6. Aronov D.M., Lupanov V.P. Function tests in cardiology. Moscow: Meditsina; 2002. Russian (Аронов Д. М., Лупанов В. П. Функциональные пробы в кардиологии. М.: Медицина; 2002).

7. Recommendations of the European Society of Cardiology for the treatment of stable angina. Eur Heart J 2010; 31: 2501–2555.

8. Belenkov J.N., Mareev V.Y., Ageev F.T. Epidemiological studies of heart failure: state of the question. Serdechnaja Nedostatochnost' 2002;3(2):57–58. Russian (Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. Эпидемиологические исследования сердечной недостаточности: состояние вопроса. Сердечная недостаточность 2002;3(2):57–58).

9. Shakhova E.B. The dynamics of echocardiographic index of left ventricule postifraction patient before and after coronary stenting. Diagnosticheskaja i Intervencionnaja Radiologija 2007; (2): 25–27. Russian (Шахова Е.Б. Динамика эхокардиографических показателей левого желудочка у постифарктных больных до и после стентирования коронарных артерий. Диагностическая Иинтервенционная Радиология 2007; (2):25–27).

10. Kastanajan A.A., Nelasov N.Ju. What we know and do not know about diastolic heart failure in the XXI century. Serdechnaja Nedostatochnost' 2009; 6(56):310–311. Russian (Кастанаян А.А., Неласов Н.Ю. Что мы знаем и чего не знаем о диастолической сердечной недостаточности в XXI веке. Сердечная Недостаточность 2009; 6(56): 310–311).

11. Vasan R., Benjamin T., Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995; 26:1565–1574

12. McKenney P.A., Apstein C.S., Mendes L.A. et al. Increased left ventricular diastolic chamber stiffness immediately after coronary artery bypass surgery. J. Am Coll Cardiol 1994;24:1189–94.

13. GorcsanJ.Jr, Diana P., Lee J. et al. Reversible diastolic disfunction after successful coronary artery bypass surgery. Assessment by transesofageal Doppler echocardiography. Chest 1994; 106: 1364–69.

14. Krasnickij V.B., Sechenova E.V., Bubnova M.G., Aronov D.M. et al. The use of a short program of physical training in patients with coronary heart disease after endovascular (coronary) interventions in an integrated program of rehabilitation and secondary prevention in the dispensary-polyclinic stage. Kardiologiia 2010; (10):30–32. Russian (Красницкий В.Б., Сеченова Е.В., Бубнова М.Г., Аронов Д.М. и др. Применение короткой программы физических тренировок у больных ишемической болезнью сердца после эндоваскулярных (коронарных) вмешательств в комплексной программе реабилитации и вторичной профилактики на диспансерно-поликлиническом этапе. Кардиология 2010; (10):30–32).

15. Meerson F.Z., Pshennikova M.G. Adaptation to the stress situations and physical stress. Moscow: Med-icina, 1988. Russian (Меерсон Ф.3., Пшенникова М.Г. Адаптация к стрессорным ситуациям и физическим нагрузкам. М.: Медицина, 1988).

16. Buziashvili Ju.I., Hananashvili E.M., Burduli N.M. Diastolic left ventricular function in patients with is-chemic heart disease without a history of myocardial infarction before and after surgery artocoronary bypass surgery. Kardiologiia 2001;(12):30–35. Russian (Бузиашвили Ю.И., Хананашвили Е.М., Бурдули Н.М. и др. Диастолическая функция левого желудочка у больных ишемической болезнью сердца без инфаркта миокарда в анамнезе до и после операции аортокоронарного шунтирования. Кардиология 2001;(12):30–35).

17. Kruger M, Linke W.A. Titin-based mechanical signaling in normal and failing myocardium. J Mol Cell Cardiol 2009;46:490–498.

18. American College of Sports Medicine Position stand. Exercise for patients with coronary artery disease. Med Sci Sports Exerc 1994; 26(3): i-v.

19. Cox M.H. Exercise training programs and cardiorespiratory adaption. Clin Sports Med 1991; 10(1): 19–32.