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Abramovich SG, Knyazyuk OO, Mikhalevich IM, Drobyshev VA, Shchedreeva EA. [Rehabilitation potential of patients with ischemic heart disease who underwent autovenous coronary artery bypass surgery in the evaluation of rehabilitation treatment effectiveness]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2024; 101:29-39. [PMID: 39487617 DOI: 10.17116/kurort202410105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2024]
Abstract
The search for methods to assess the rehabilitation potential (RP) of patients with ischemic heart disease (IHD) who underwent coronary artery bypass surgery (CABS), which will allow to personalize approaches to the administration of necessary for the certain patient treatment complexes, increasing their effectiveness and reducing the probability of complications, remains relevant. OBJECTIVE To develop a method for RP evaluation in patients with IHD who underwent CABS and to assess its role in predicting the effectiveness of therapeutic activities in the early rehabilitation period. MATERIAL AND METHODS The study consisted of two parts. A method for RP assessment in 118 patients with IHD aged 36-85 years (mean age 62.3±2.0 years) who underwent CABS was developed in the 1st part based on the analysis of hospital discharge reports using mathematical modeling methods. The results of rehabilitation activities were analyzed in the 2nd part of the study in patients who were transferred to the cardiovascular department of the Angara Clinical Resort after the cardiovascular surgery department for the second stage of rehabilitation. The multidisciplinary team evaluated the effectiveness of patients' treatment after the rehabilitation completion using integral indicators characterizing clinical condition of the patient who underwent CABS. RESULTS A methodological algorithm was created in the 1st part of the study, namely a formalized patient chart was formed, the evidence base was represented by 99 indicators. The values of linear classification functions' coefficients were assigned to certain indicators, according to which the patient was classified into one of four groups: the 1st group - without RP; the 2nd group - with medium RP; the 3rd group - with high RP and the 4th group - with low RP. The values of RP were determined in the second part of the study for predicting the effectiveness of therapeutic measures in the early rehabilitation period (the second stage of medical rehabilitation). It has been found that the greatest effect was observed in subjects of the 3rd group with high RP in the patients' testing after treatment at the health resort. The lesser effect has been noted in patients of the 2nd group and especially of the 4th group. CONCLUSIONS The use of RP assessment method based on mathematical modeling in patients who underwent CABS allows to predict the results of patients' medical rehabilitation at the second stage in the health resort conditions.
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Affiliation(s)
- S G Abramovich
- Irkutsk State Medical Academy of Postgraduate Education - branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russia
| | - O O Knyazyuk
- Irkutsk State Medical Academy of Postgraduate Education - branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russia
- AO «Angara Clinical Resort», Irkutsk, Russia
| | - I M Mikhalevich
- Irkutsk State Medical Academy of Postgraduate Education - branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russia
| | - V A Drobyshev
- Novosibirsk State Medical University, Novosibirsk, Russia
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Kaveshnikov VS, Kuzmichkina MA, Serebryakova VN. Predictors of Long-Term Outcomes after Surgical Myocardial Revascularization. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2023. [DOI: 10.20996/1819-6446-2022-12-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
High mortality from cardiovascular diseases (CVD) requires improved approaches to the treatment of this socially significant pathology. Wide implementation of surgical myocardial revascularization makes it possible to improve significantly both life quality and expectancy in patients with coronary heart disease. The aim of this work was to analyze the literature on the impact of preoperative, operative and postoperative factors on the long-term prognosis after coronary artery bypass grafting (CABG). The review refers to both recent and earlier informative works. The target groups for this article are therapists, cardiologists, rehabilitologists, who work with patients in the short and long term after CABG. Data of Russian and foreign literature show that the long-term prognosis after CABG is largely determined by preoperative factors, in particular – age, set of cardiovascular risk factors (RF) and comorbidity, specifically – severity of coronary and systemic atherosclerosis, incident cardiovascular complications, structural and functional state of the heart. In the aggregate these factors reflect the cumulative effect and further potential of actual cardiovascular RFs, affect longterm risk of adverse events, and determine the therapeutic targets of secondary prevention. Priority of arterial conduits and completeness of revascularization are the main operative factors that determine the course of the long-term period after CABG. Among the postoperative factors, the efficiency of secondary CVD prevention is of paramount importance, in particular – achievement of target RF levels, compensation of cardiac and extracardiac pathology, adherence to the long-term medical therapy, known to improve outcomes based on specific comorbidity. Efficiency of secondary CVD prevention largely depends on patient's health attitudes, the key influence on which beyond attending physician can be provided by participation in rehabilitation programs, teaching patients the meaning and essentials of lifestyle modification and cardiovascular RFs’ control.
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Affiliation(s)
- V. S. Kaveshnikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - M. A. Kuzmichkina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
| | - V. N. Serebryakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
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Lyapina IN, Shaleva VA, Teplova YE, Pomeshkina SA, Barbarash OL. Effect of early postoperative rehabilitation with aerobic exercise on functional status and cardiac remodeling in patients after heart valve surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2023-3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Aim. To develop a program for early physical rehabilitation of inpatients after heart valve surgery and to evaluate its effectiveness and safety.Material and methods. The study included 80 patients with valvular heart disease (VHD) after elective on pump valve surgery. Patients in the control group (n=47) underwent standard cardiac rehabilitation after surgery; patients of the main group (n=33) additionally, starting from the 8th day after the intervention, had 14-day treadmill training with the program selection, taking into account the results of cycle ergometry spirometry (CES). A week after the operation and at the end of the training course (median, 24 days after the operation), cardiac remodeling and functional status was assessed according to echocardiography and CE, respectively.Results. For 7 days after surgery, patients of both groups were comparable. During physical training in the main group, there were no lifethreatening cardiac arrhythmias, episodes of ischemia, desaturation, as well as intracardiac hemodynamics deterioration. With a 14-day training, CES showed a significant increase in exercise tolerance (ET) in the main group from a median of 50 to 75 W (p=0,002), peak oxygen uptake (VO2peak) from 11,7 to 13,4 ml/kg/min (p=0,001). For 24 days after surgery in the control group, there was a trend towards improvement in ET and VO2peak, but without significant changes (p=0,09/p=0,08).Conclusion. Early inhospital rehabilitation, including physical training of moderate intensity with an individual treadmill speed and incline angle, starting from day 8 after surgery, showed effectiveness and safety in the form of an increase in ET and VO2peak, while not worsening hemodynamic parameters.
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Affiliation(s)
- I. N. Lyapina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V. A. Shaleva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - Yu. E. Teplova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. A. Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Fedorov AA, Kaisinova AS, Mazyrina MV, Amiyants VY, Akhubekova NK, Gaidamaka II, Efimenko NV, Chalaya EN, Korchazhkina NB, Popov SO. [High-tone therapy in complex rehabilitation of patients with post-sternotomy syndrome after coronary artery bypass surgery. (Open-label, prospective, randomized controlled trial)]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:14-20. [PMID: 38289300 DOI: 10.17116/kurort202310006114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION At present it remains relevant to develop new rehabilitation technologies for patients with circulatory system diseases who have undergone a cardiac surgery to restore the functions of the cardiorespiratory system more quickly, improve physical and mental health, and prevent the development of the atherosclerotic process. AIM To study the effectiveness and safety of the new rehabilitation technology for the inpatient stage of medical rehabilitation of patients with post-sternotomy syndrome after coronary artery bypass surgery (CABS) using high-tone therapy. MATERIAL AND METHODS The study included 85 men (the average age was 56.8±2.46 years old) with post-sternotomy syndrome after CABS. They were divided into two groups by simple randomization: the first/main (42 patients) and the second/control (43 patients). The control group of the patients had a standard rehabilitation complex; the main group was additionally prescribed a high-tone therapy according to a local method. The immediate results of the treatment were assessed by the dynamics of the clinical picture, the six-minute walk test, respiratory function, echocardiography, the level of cytokines, C-reactive protein and natriuretic peptide (NT-proBNP); distant - by QOL endpoints (questionnaire MOS SF-36). RESULTS The groups of the patients were comparable in all baseline parameters. After the course of the procedures in the main group of patients there were positive reliable (p<0.05-0.001) shifts in clinical (pain, shortness of breath, general weakness), functional (forced expiratory vital capacity, forced expiratory volume1, effusion separation) and laboratory parameters (leukocytes, interleukin-2 and 10, NT-proBNP). The intergroup analysis of long-term results registered significant (p<0.05) differences in the QOL of patients in the main group by subscales: the role of somatic problems, vitality and mental health. Compliance to the III stage of medical rehabilitation (outpatient/home) was noted with 95.2% of the patients in the first group and 93.0% in the second. CONCLUSION The additional appointment of a high-tone therapy to the rehabilitation standard for the patients with post-sternotomy syndrome after CABS significantly improves the immediate and long-term results of the treatment (QOL) contributing to a more pronounced reverse development of inflammatory and edematous syndromes, an increase in physical activity and psychosomatic health. The absence of adverse reactions with all the patients indicates the safety of rehabilitation complexes.
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Affiliation(s)
- A A Fedorov
- Urals State Medical University, Yekaterinburg, Russia
- Yekaterinburg Medical Research Center for Prophylaxis and Health Protection of Industrial Workers, Yekaterinburg, Russia
| | - A S Kaisinova
- North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency, Essentuki, Russia
- Pyatigorsk Medical and Pharmaceutical Institute - branch of Volgograd State Medical University, Pyatigorsk, Russia
| | - M V Mazyrina
- Regional specialized medical rehabilitation centre «Lake Chusovskoye, » Yekaterinburg, Russia
| | - V Yu Amiyants
- North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency, Essentuki, Russia
| | - N K Akhubekova
- North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency, Essentuki, Russia
| | - I I Gaidamaka
- Stavropol State Medical University, Stavropol, Russia
| | - N V Efimenko
- North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency, Essentuki, Russia
| | - E N Chalaya
- North Caucasian Federal Scientific and Clinical Centre of Federal Medical and Biological Agency, Essentuki, Russia
| | | | - S O Popov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Bazdyrev ED, Terentyeva NA, Galimova NA, Krivoshapova KE, Barbarash OL. Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function.
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Affiliation(s)
- E. D. Bazdyrev
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - N. A. Terentyeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - N. A. Galimova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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Pomeshkina SA, Bezzubova VA, Zvereva TN, Kagan ES, Barbarash OL. Factors affecting adherence to physical training in the outpatient phase of rehabilitation, in patients after coronary artery bypass grafting. KARDIOLOGIIA 2022; 62:37-44. [PMID: 35834340 DOI: 10.18087/cardio.2022.6.n1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/29/2021] [Indexed: 06/15/2023]
Abstract
Aim To evaluate the outpatient physical exercise (PE) compliance and the affecting factors in patients after coronary bypass (CB).Material and methods The study included 67 men with ischemic heart disease younger than 75 years who had had CB. All patients were randomized to 2 groups: group 1 exercised on a bicycle ergometer at the rehabilitation center, under the monitoring of medical staff; patients of group 2 performed home-based exercise (HBE) by dosed walking. In the preoperative period, at one month after CB, and after 3 months of exercise, the following was evaluated: clinical condition of patients in different groups, plasma concentrations of lipids, body weight index, waist circumference, echocardiography and bicycle ergometry data, and questionnaire data (SF-36, Bek's Depression Inventory). At 3 months of follow-up, the outpatient exercise compliance and the affecting factors were also evaluated.Results The study demonstrated the effectiveness of the proposed alternative 3-month program of home-based PE. Both the patients exercising on a bicycle and those performing HBE had increased exercise tolerance (ET) and improved blood lipid concentrations. The number of obese patients decreased. Also, depression severity decreased, quality of life (physical and psychological components) improved, and compliance with drug therapy increased in both groups. Analysis of the training attendance in the recommended period showed that patients who had undergone CB were insufficiently adherent to physical rehabilitation programs, regardless of the program type (home-based or monitored). The highest PE adherence was observed in men with the following characteristics: married, working urban residents, with a previous history of cardiovascular diseases, who had regularly taken medications in the preoperative period, and who also had higher quality of life.Conclusion The proposed outpatient 3-month physical rehabilitation programs increase the effectiveness of CB, which is evident as improved adherence to modifying cardiovascular risk factors, increased ET, optimization of the psychological status and quality of life, and improved compliance with drug therapy. However, despite the proposed alternative, home-based 3-month physical rehabilitation programs aimed at increasing the treatment compliance, the level of ET remained low. This requires further improvement of methods for monitoring and motivation of patients to physical rehabilitation and psychological support that would start already at the preoperative stage.
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Affiliation(s)
- S A Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
| | - V A Bezzubova
- Barbarash Kemerovo Regional Clinical Cardiological Dispensary, Kemerovo
| | - T N Zvereva
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
| | - E S Kagan
- Kemerovo State Medical University, Kemerovo
| | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
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Gruzdeva OV, Dyleva YA, Belik EV, Sinitsky MY, Stasev AN, Kokov AN, Brel NK, Krivkina EO, Bychkova EE, Tarasov RS, Barbarash OL. Relationship between Epicardial and Coronary Adipose Tissue and the Expression of Adiponectin, Leptin, and Interleukin 6 in Patients with Coronary Artery Disease. J Pers Med 2022; 12:jpm12020129. [PMID: 35207618 PMCID: PMC8877574 DOI: 10.3390/jpm12020129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
Adipose tissue (AT) is an endocrine and paracrine organ that synthesizes biologically active adipocytokines, which affect inflammation, fibrosis, and atherogenesis. Epicardial and perivascular fat depots are of great interest to researchers, owing to their potential effects on the myocardium and blood vessels. The aim of the study was to assess the expression and secretion of adipocytokine genes in the AT of patients with coronary artery disease (CAD) and patients with aortic or mitral valve replacement. This study included 84 patients with CAD and 50 patients with aortic or mitral valve replacement. Adipocytes were isolated from subcutaneous, epicardial (EAT), and perivascular AT (PVAT), and were cultured for 24 h. EAT exhibited the lowest level of adiponectin gene expression and secretion, regardless of nosology, and high expression levels of the leptin gene and interleukin-6 (IL-6). However, EAT adipocytes in patients with CAD were characterized by more pronounced changes in comparison with the group with heart defects. High leptin and IL-6 levels resulted in increased pro-inflammatory activity, as observed in both EAT and PVAT adipocytes, especially in individuals with CAD. Therefore, our results revealed the pathogenetic significance of alterations in the adipokine and cytokine status of adipocytes of EAT and PVAT in patients with CAD.
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Bubnova MG, Aronov DM, Sprikut AA, Stankevich DI, Poddubskaya EA, Persiyanova-Dubrova AL. Prehabilitation as an important stage before cardiac surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review discusses the preparation of patients for surgery on the heart and other organs. We considered the importance of introducing a new stage of medical and cardiology rehabilitation — prehabilitation. The results of randomized clinical trials, systematic reviews and metaanalyzes evaluating the effectiveness of respiratory techniques and physical training during the prehabilitation are presented. Particular attention is paid to the involvement of patients in prehabilitation programs before the elective coronary artery bypass grafting. Methodological problems arising in the development of prehabilitation programs are discussed.
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Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. M. Aronov
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | - E. A. Poddubskaya
- National Medical Research Center for Therapy and Preventive Medicine
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Arkhipova NV, Argunova YA, Pomeshkina EE. [Unresolved issues in the prevention of bronchopulmonary complications in a cardiac surgery patient from the standpoint of a rehabilitation therapist]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2021; 98:65-69. [PMID: 33899454 DOI: 10.17116/kurort20219802165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bronchopulmonary complications are one of the leading causes of morbidity after cardiac surgery; they lengthen a patient's hospital stay and increase the cost of treatment. The most common postoperative bronchopulmonary complications include pneumonia, atelectasis, respiratory failure, pneumothorax, and bronchospasm. These complications are the consequences of anesthesia and surgical trauma aggravated by the presence of risk factors in the patient in the preoperative period such as any chronic disease involving the lungs, smoking history, persistent cough and / or wheezing, chest and spinal deformities, obesity, senior age. In addition, the presence of chronic heart failure, diabetes mellitus, and chronic kidney disease also increase the risk of developing bronchopulmonary complications. In the prevention and treatment of bronchopulmonary complications the clinical effectiveness of rehabilitation programs after coronary artery bypass grafting is undeniable. The effectiveness of the programs has been proven on the basis of both domestic and foreign long-term in-practice and scientific research. However, despite the significant advances in cardiac rehabilitation there are a number of unresolved issues. Is it possible in a short period of time of the first stationary rehabilitation stage to form the patient's skill to perform breathing exercises and, accordingly, to obtain the maximum effect in the prevention of bronchopulmonary complications? What factors can affect the speed of motor skill formation in the patient's mastering of breathing exercises? What should be the frequency of procedures per day and the number of exercises when a physical therapy instructor works with a patient to increase the effectiveness of the prevention of bronchopulmonary complications in the postoperative period? What category of patients is strictly required for the pre-rehabilitation stage? How should the pre-rehabilitation stage be organized and how long should it take? All these questions require the work-out and implementation of scientifically grounded individual rehabilitation programs with a step-by-step algorithm for managing the patient by a rehabilitation multi-team from the first hours after surgery with the mandatory inclusion of pre-rehabilitation and taking into account the social, anamnestic, clinical and psychological characteristics of the patient.
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Affiliation(s)
- N V Arkhipova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Yu A Argunova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E E Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Gusakova AM, Nasrashvili GG, Trubacheva OA, Saushkin VV, Gorchakova MB, Kozlov BN, Suslova TE. Bone Remodeling Markers in Assessing of Sternal Reparative Regeneration in Patients With Carbohydrate Metabolism Disorders After Coronary Bypass Surgery. ACTA ACUST UNITED AC 2021; 61:47-53. [PMID: 33734045 DOI: 10.18087/cardio.2021.2.n1432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/11/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022]
Abstract
Aim To study time-related changes in bone remodeling markers in patients with ischemic heart disease (IHD) associated with type 2 diabetes mellitus (DM) and disorders of carbohydrate metabolism (CM). Also, a possibility was studied of using these markers for evaluation of breast bone reparative regeneration in early and late postoperative periods following coronary bypass (CB).Materials and methods This study included 28 patients with IHD and functional class II-III exertional angina after CB. Patients were divided into 2 groups based on the presence (group 1) and absence (group 2) of CM disorders. Contents of osteocalcin (OC), C-terminal telopeptide (CTTP) of type 1 collagen, deoxypyridinoline (DPD), and alkaline phosphatase bone isoenzyme (ALPBI) were measured by enzyme immunoassay on admission (Т1) and at early (Т2) and late (Т3) postoperative stages. Sternal scintigraphy with a radiopharmaceutical (RP) was performed at stage 3 following sternotomy.Results The content of OC and CTTP was reduced in group 1 compared to the values in the group without CM disorders (р<0.005) at stages Т1 and Т2. There were no significant intergroup differences in concentrations of ALPBI and DPD throughout the study. Time-related changes in OC, CTTP, and DPD had some intergroup differences: the increase in biomarkers was observed in group 1 considerably later, at stage Т3 (р<0.005), while in group 2, it was observed at stage T2 after sternotomy. Scintigraphy revealed significant intergroup differences in the intensity of RP accumulation in sternal tissue.Conclusion The intergroup differences in the content of biomarkers evidenced a disbalance among processes of formation and resorption of bone tissue and delayed remodeling processes in patients with IHD associated with type 2 DM and CM disorders. The study confirmed significance of comprehensive evaluation of time-related changes in markers for bone tissue metabolism and sternal scintigraphy for diagnosis and evaluation of sternal reparative regeneration following sternotomy in patients with IHD associated with type 2 DM and disorders of CM metabolism.
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Affiliation(s)
- A M Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - G G Nasrashvili
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - O A Trubacheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - V V Saushkin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | | | - B N Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - T E Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
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Argunova YA, Zvereva TN, Pomeshkina SA, Ivanova AV, Polikutina OM, Gruzdeva OV, Kashtalap VV, Barbarash OL. Optimization of a Comprehensive Prehabilitation Program for Patients with Stable Coronary Artery Disease Undergoing Elective Coronary Artery Bypass Grafting. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-08-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To evaluate the effectiveness of a comprehensive prehabilitation program including the optimization of drug therapy for patients undergoing elective coronary artery bypass grafting (CABG).Material and methods. 56 male patients with stable angina referred to elective on-pump CABG were enrolled in a study. All patients were screened for eligibility according to the inclusion/exclusion criteria and then randomized into two groups. Group 1 patients (n=28) underwent preoperative management (prehabilitation) for 14 days, including patient education and physical rehabilitation. Trimetazidine in a dose of 80 mg per day was added to the standard drug therapy. Group 2 patients (n=28) underwent similar preoperative management, but with the standard drug therapy without trimetazidine. In addition to the routine methods of preoperative management, all patients underwent the 6-minute walk test (6MWT) to assess exercise tolerance and speckle tracking echocardiography to measure left ventricular (LV) longitudinal deformation. Serum troponin T was measured in all patients. The measurements were performed at admission and after the surgery.Results. Patients did not differ in the main clinical and demographic data, as well as the main preoperative speckle tracking echocardiography findings. The intraoperative parameters were comparable in both groups. The rate of early postoperative complications was 61% (n=17) in Group 1 and 64% (n=18) in Group 2 (p>0.05). LV ejection fraction significantly decreased postoperatively in both groups (p<0.01) as well as LV longitudinal deformation as compared to the baseline. Patients receiving the standard therapy without trimetazidine reported a significant decrease in the longitudinal strain after CABG compared with the baseline (p=0.01). There were no statistically significant differences in most preoperative and postoperative indicators of longitudinal deformation among patients treated with trimetazidine. Postoperative values of GLPS-LAX and GLPS-Avg were significantly higher in the trimetazidine group than those in the control group (p=0.04). Group 1 patients reported longer distance covered in 6MWT than Group 2 patients while assessing exercise tolerance: 370.0 [260.0;415.0] vs 242.0 [202.0;350.0] m, respectively (p=0.0059).Conclusion. The addition of trimetazidine in a dose of 80 mg daily in the prehabilitation program for patients undergoing elective CABG demonstrated better postoperative indicators of LV longitudinal deformation and an increase in exercise tolerance. Obtained findings allowed considering this approach to the preoperative management as an additional method of cardiac protection and optimization of the functional status of patients.
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Affiliation(s)
- Yu. A. Argunova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - T. N. Zvereva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - S. A. Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. V. Ivanova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. M. Polikutina
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. V. Gruzdeva
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V. V. Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
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12
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Polyakova EA, Zaraiskii MI, Mikhaylov EN, Baranova EI, Galagudza MM, Shlyakhto EV. Association of myocardial and serum miRNA expression patterns with the presence and extent of coronary artery disease: A cross-sectional study. Int J Cardiol 2020; 322:9-15. [PMID: 32798621 DOI: 10.1016/j.ijcard.2020.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/22/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND MicroRNA (miRNAs) participate in the pathogenesis of coronary artery disease (CAD). OBJECTIVE To evaluate the expressions of myocardial and serum miRNA-27а, miRNA-133а, and miRNA-203 in CAD patients. METHOD This cross-sectional observational study comprised 100 subjects (60.9 ± 1.0 years; 67% men). The right atrial and serum expressions of miRNA-27a, miRNA -133a, and miRNA-203 in 80 patients referred for elective coronary artery bypass graft surgery (CABG) and 20 control patients scheduled for heart valve surgery were analyzed using real-time polymerase chain reaction. RESULTS There was a positive correlation between the SYNTAX score I index and serum miRNA-203 expression level (r = 0.693; p < .001). Patients with ≥3 coronary artery lesions had significantly higher myocardial expressions of miRNA-27a, miRNA-133а, and miRNA-203 than patients with 1-2 vessel disease in the atrial myocardium (miRNA-27a: 234.62 ± 29.51 vs. 182.39 ± 19.62 relative expression unit (REU); miRNA-133а: 127.53 ± 13.41 vs. 111.35 ± 12.31 REU; and miRNA-203: 5.25 ± 0.96 vs. 4.71 ± 0.67 REU; р < 0.05); the same association was found for serum miRNA expressions (miRNA-27a: 11.41 ± 3.85 vs. 4.82 ± 1.82 REU; miRNA-133а: 8.42 ± 2.43 vs. 4.35 ± 1.23 REU; and miRNA-203: 145.71 ± 15.73 vs. 43.70 ± 9.67 REU; р < 0.05). The decision tree method established that the risk of multivessel lesions was increased five-fold if the miRNA-203 serum expression was >101.00 REU (OR, 5.90; 95% CI, 2.34-9.46; p < .001). CONCLUSIONS Both myocardial and serum miRNA-27а, miRNA-133а, and miRNA-203 expressions are higher in CABG patients than in non-CAD subjects. The serum miRNA-203 expression level corresponds to myocardial expression and is strongly correlated with the extent of coronary atherosclerosis.
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Affiliation(s)
- E A Polyakova
- Pavlov First Saint-Petersburg State Medical University, Lev Tolstoy str., 6-8, Saint-Petersburg 197022, Russia; Almazov National Medical Research Centre, Akkuratova str., 2, Saint-Petersburg 197341, Russia.
| | - M I Zaraiskii
- Pavlov First Saint-Petersburg State Medical University, Lev Tolstoy str., 6-8, Saint-Petersburg 197022, Russia
| | - E N Mikhaylov
- Almazov National Medical Research Centre, Akkuratova str., 2, Saint-Petersburg 197341, Russia; Saint-Petersburg Electrotechnical University "LETI", Professor Popov str., 5, Saint Petersburg 197376, Russia
| | - E I Baranova
- Pavlov First Saint-Petersburg State Medical University, Lev Tolstoy str., 6-8, Saint-Petersburg 197022, Russia; Almazov National Medical Research Centre, Akkuratova str., 2, Saint-Petersburg 197341, Russia
| | - M M Galagudza
- Pavlov First Saint-Petersburg State Medical University, Lev Tolstoy str., 6-8, Saint-Petersburg 197022, Russia; Almazov National Medical Research Centre, Akkuratova str., 2, Saint-Petersburg 197341, Russia
| | - E V Shlyakhto
- Pavlov First Saint-Petersburg State Medical University, Lev Tolstoy str., 6-8, Saint-Petersburg 197022, Russia; Almazov National Medical Research Centre, Akkuratova str., 2, Saint-Petersburg 197341, Russia
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13
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Pobozheva IA, Razgildina ND, Polyakova EA, Panteleeva AA, Belyaeva OD, Nifontov SE, Galkina OV, Kolodina DA, Berkovich OA, Baranova EI, Pchelina SN, Miroshnikova VV. [Epicardial and subcutenious adipose tissue adiponectin gene expression in coronary artery disease patients]. KARDIOLOGIYA 2020; 60:62-69. [PMID: 32394859 DOI: 10.18087/cardio.2020.4.n517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/01/2019] [Accepted: 01/23/2020] [Indexed: 11/18/2022]
Abstract
Aim To determine the expression of adiponectin gene (ADIPOQ) and the content of high-molecular-weight adiponectin (HMWA) in epicardial (EAT) and subcutaneous adipose tissue (SCAT) in patients with ischemic heart disease (IHD).Material and methods Paired samples of EAT and SCAT and blood serum were withdrawn from patients with IHD after bypass surgery and 16 subjects without IHD (comparison group). Matrix RNA (mRNA) level was measured using real-time polymerase chain reaction. HMWA levels in EAT and SCAT were evaluated by Western blotting. Serum adiponectin concentration was measured immunoenzymatically. For all patients, echocardiography was performed to measure the EAT thickness; coronarography was performed to determine severity of coronary atherosclerosis.Results Serum adiponectin concentration was lower in IHD patients than in the comparison group (p<0.001). Levels of ADIPOO gene mRNA and HMWA in SCAT were lower in IHD patients than in the comparison group (р=0.020 and p=0.003, respectively). The HMWA level in EAT was lower with the EAT thickness of 8 mm compared to the HMWA level in IHD patients with EAT ≤8 mm (p=0.034).Conclusion The decreased serum concentration of antiatherogenic adiponectin and the reduced expression of ADIPOQ gene in SCAT (mRNA, HMWA) are associated with IHD.
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Affiliation(s)
- I A Pobozheva
- NRC «Kurchatov Institute» - PNPI Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | | | - E A Polyakova
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - A A Panteleeva
- NRC «Kurchatov Institute» - PNPI Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - O D Belyaeva
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - S E Nifontov
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - O V Galkina
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - D A Kolodina
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - O A Berkovich
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - E I Baranova
- Acad. I.P. Pavlov First St.-Petersburg State Medical University
| | - S N Pchelina
- NRC «Kurchatov Institute» - PNPI Acad. I.P. Pavlov First St.-Petersburg State Medical University
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14
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Barbarash OL, Kashtalap VV, Zykov MV, Hryachkova ON, Shibanova IA. [The Pathways to Increase the Efficacy of Drug Therapy in Patients with Ischemic Heart Disease after Coronary Artery Bypass Grafting]. ACTA ACUST UNITED AC 2019; 59:12-17. [PMID: 31242836 DOI: 10.18087/cardio.2019.6.n536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE to assess drug therapy and achievement of target parameters of treatment in patients with ischemic heart disease (IHD) during 3-5 years of follow-up aſter coronary bypass surgery. MATERIALS AND METHODS From the initial sample of the coronary bypass surgery registry (n=680) we selected for this study 111 men (mean age 61 [55; 65] years) hospitalized in 2011 with clinical picture of IHD for coronary artery bypass graſting (CABG). RESULTS Mean duration of follow-up was 4.2 years. Mortality was 11.7 % (n=13), 11 deaths were cardiovascular, 2 - from unknown causes. End points defined as repeat hospitalizations and IHD progression were registered in 18 of 98 patients (18.4 %). Only in 25 % of patients during 3-5 years of observation aſter CABG there were no clinical signs of angina. Five patients (5.1 %) developed new type 2 diabetes. Drug therapy: 80 patients (81.6 %) received acetylsalicylic acid, 60 (61.2 %) - angiotensin converting enzyme inhibitors, 80 (81.6 %) - β-adrenoblockers. Eighty-one men (82.6 %) received statins, but only 20 of 98 re-examined patients (20.4 %) took high doses. Target levels of low density lipoprotein cholesterolConclusion. Data of clinical practice illustrate insufficient quality of basic and antianginal therapy in patients with IHD aſter CABG. Indicators of control of angina, heart rate, achievement of target levels of parameters of lipid metabolism remain unsatisfactory.
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Affiliation(s)
- O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
| | - V V Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
| | - M V Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - O N Hryachkova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - I A Shibanova
- Research Institute for Complex Issues of Cardiovascular Diseases
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15
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Argunova YA, Pomeshkina SA, Khaes BL, Barbarash OL. [The personalized approach to the rehabilitation of a severely ill patient presenting with a cardio-surgical problem]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2019; 96:50-54. [PMID: 30724882 DOI: 10.17116/kurort20199601150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ever increasing number of the patients presenting with the cardio-surgical problems referred for surgery emphasizes the importance of the treatment of the cases of post-operative complications based on the personalized approach. The present article was designed to report a clinical case of the successful surgical treatment and rehabilitation of a patient presenting with the dysfunction of the bioprosthetic mitral valve and complications of the post-operative course in the form of polyorgan insufficiency with the predominance of respiratory failure. Special attention is given to the post-operative complications among which the respiratory insufficiency prevailed that made necessary the long period of artificial pulmonary ventilation. The specific features of the intense personalized approach to the physical rehabilitation of the given severely ill patient based at the intensive care unit are considered, the description of the methods applied for the purpose is presented, and their effectiveness from the perspective of clinical and functional parameters is evaluated. The study has demonstrated that the application of the intensive personalized approach in the given case turned out to be a safe and effective method of rehabilitation. The use of the proposed approach allowed to shorten the duration of the post-operative rehabilitation period, facilitated the patient's transfer to autonomous breathing and expansion of the motor activity under conditions of the intensive care unit. In addition, the use of the continuity principle and continuation of rehabilitation measures based at the cardiac surgery department provided the opportunity for the further expansion of the motor activity.
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Affiliation(s)
- Yu A Argunova
- Research Institute of Complex Problems of Cardio-Vascular Diseases, Kemerovo, Russia
| | - S A Pomeshkina
- Research Institute of Complex Problems of Cardio-Vascular Diseases, Kemerovo, Russia
| | - B L Khaes
- Research Institute of Complex Problems of Cardio-Vascular Diseases, Kemerovo, Russia
| | - O L Barbarash
- Research Institute of Complex Problems of Cardio-Vascular Diseases, Kemerovo, Russia
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Argunova YA, Pomeshkina IA, Inozemtseva AA, Moskin EG, Barbarash OL. Clinical efficiency of prehabilitation program in patients undergoing coronary artery bypass grafting. ACTA ACUST UNITED AC 2019. [DOI: 10.17802/2306-1278-2018-7-4s-15-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aim.To evaluate clinical efficacy of high-intensity exercise training included in the prehabilitation program for elective coronary artery bypass grafting (CABG).Methods. 38 male patients were included in the study before on-pump CABG. After fulfilling the inclusion/exclusion criteria, patients were randomized into two groups: Group 1 patients (n = 20) underwent supervised treadmill exercise, and Group 2 patients (n = 18) were referred to surgery without any exercise training. Patients underwent a 7-day exercise training with daily measurements of hemodynamic parameters and electrocardiogram (ECG) monitoring. The load intensity was measured with cardiopulmonary exercise testing and accounted for 80% of the maximal oxygen uptake. Postoperative complications were recorded in the in-hospital period and analyzed. Quality of life indicators were measured by the SF-36 standard version 7–10 days prior to surgery and on days 7-10 of the postoperative period. Adherence to drug and non-drug therapy was assessed during the 6-month follow-up.Results.There was a significantly lower incidence of postoperative complications during the in-hospital period in patients undergoing prehabilitation program with supervised high-intensity exercise training, compared with patients without any exercise training (p = 0.002). Group 1 patients had reliably better mental health (MH) scores compared with Group 2 patients (48.9±7.60 vs. 39.1±6.80 scores, respectively; p = 0.03) on days 7–10 after CABG. Six months after the CABG, patients who underwent prehabilitation exercise training were less likely to resume smoking than patients without any exercise training (p = 0.04). The tendency towards improved adherence to drug therapy and compensation in arterial hypertension has been determined among Group 1 patients.Conclusion. Exercise training included in the prehabilitation program proved to be safe and effective in terms of improved clinical outcomes after CABG, quality of life and adherence to treatment in this group of patients.
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Affiliation(s)
- Y. A. Argunova
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases
| | - I. A. Pomeshkina
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases
| | - A. A. Inozemtseva
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases
| | - E. G. Moskin
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases
| | - O. L. Barbarash
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases
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17
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Aronov DM. History of cardiac rehabilitation in Russia. ACTA ACUST UNITED AC 2018; 58:14-21. [PMID: 30625086 DOI: 10.18087/cardio.2604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
The review presents the history of establishing cardiac rehabilitation for patients who have had acute myocardial infarction, acute coronary conditions, cardiac and vascular surgery, and intravascular interventions. Stages and physiological basis of this treatment are described.
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Affiliation(s)
- D M Aronov
- National Research Center for Preventive Medicine.
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18
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Ivanova OА, Kuklin SG. THE RATE OF CARDIAC RHYTHM RECOVERY POST EXERTION IN PHYSICAL REHABILITATION OF CARDIOLOGICAL PATIENTS. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-2-95-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Taken the rising mortality and morbidity of the population due to cardiovascular diseases (CVD), rehabilitation of cardiovascular patients remains actual. Regular exercises are the leading components of cardiorehabilitation, that is evidently beneficial. Taken this, the question raises on the adequacy and efficacy of training regimens. Utilization of the parameter representing the velocity of heart rate decline by every minute of recovery phase after the exertion, is quite informative. The borderline set for heart rate, with increasing cardiovascular risk if below. Dynamics of such parameter during the programs of physical rehabilitation might be a marker of the events efficacy. Recently, there is a deficiency of information on the normal parameters of heart rate recovery rate in CVD patients. Hence a question raises, on the unification of approaches in evaluation of recovery period and data collection on the influence of long term exercises on CVD prognosis.
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Affiliation(s)
- O. А. Ivanova
- Irkutskaya State Medical Academy of Postgraduate Education — branch of FSBEI CPE “Russian Medical Academy of Continuous Professional Development” of the Ministry of Health
| | - S. G. Kuklin
- Irkutskaya State Medical Academy of Postgraduate Education — branch of FSBEI CPE “Russian Medical Academy of Continuous Professional Development” of the Ministry of Health
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