Effects of Physical Prehabilitation on the Dynamics of the Markers of Endothelial Function in Patients Undergoing Elective Coronary Bypass Surgery
Abstract
:1. Introduction
2. Material and Methods
2.1. Patients
- Severe concomitant diseases that prohibit stress testing and physical training (severe chronic obstructive pulmonary disease, acute inflammation, skeletal and muscular system pathologies, and post-stroke recrudescence);
- A combination of coronary heart disease and valvular heart defects, and a left ventricular (LV) aneurysm;
- Scheduled brachiocephalic arterial reconstruction;
- Severe arrhythmias and conduction disorders, as well as atrial fibrillation;
- Thrombophlebitis and varicose veins of lower extremities with chronic venous insufficiency (class 3–4);
- Lower-extremity atherosclerosis with chronic limb ischemia higher than stage IIA, and peripheral arterial reconstruction in medical history;
- Aneurysms and aortic dissection;
- Decompensated chronic heart failure (CHF);
- NYHA class IV angina pectoris and NYHA class III CHF (and higher);
- Uncontrolled arterial hypertension (AH);
- A left ventricular ejection fraction (LV EF) less than 40%;
- Acute coronary syndrome;
- Stroke in the past 6 months;
- Surgery in the past 6 months;
- Significant left main coronary artery stenosis.
2.2. Methods of Physical Training
2.3. Laboratory Methods
2.4. Postoperative Assessment
2.5. Statistical Methods
3. Results
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameters | Training Group (n = 43) | Controls (n = 35) | p |
---|---|---|---|
Age, years (Me (Q25, Q75)) | 61.5 (55, 65) | 63.0 (56, 66) | 0.43 |
Working patients, n (%) | 16 (37.2) | 12 (34.2) | 0.79 |
BMI, kg/m2 (Me (Q25, Q75)) | 29.3 (25.9, 30.9) | 28.6 (26.4, 31.6) | 0.81 |
Smoking, n (%) | 13 (30.2) | 10 (28.5) | 0.87 |
EuroScore (Me (Q25, Q75)) | 0.75 (0.6, 0.79) | 0.84 (0.68, 0.9) | 0.36 |
CHD duration, years (Me (Q25, Q75)) | 1.0 (0.5, 3.0) | 1.0 (0.5, 6.0) | 0.41 |
AH, n (%) | 36 (83.7) | 33 (94.2) | 0.15 |
AH duration, years (Me (Q25, Q75)) | 4.5 (2.0, 10.0) | 5.0 (3.0, 10.0) | 0.56 |
AF, n (%) | 2 (4.6) | 2 (5.7) | 0.82 |
Angina pectoris FC NYHA, n (%): 0-I | 10 (23.2) | 7 (20) | 0.73 |
II | 29 (67.4) | 25 (71.4) | |
III | 4 (9.3) | 3 (8.5) | |
CHF FC NYHA, n (%): 0-I | 1 (2.3) | 0 | 0.36 |
II | 42 (97.7) | 35 (100) | |
Prior myocardial infarction, n (%) | 30 (69.7) | 22 (62.8) | 0.52 |
History of prior stroke, n (%) | 3 (6.9) | 2 (5.7) | 0.83 |
DM in medical history, n (%) | 9 (20.9) | 7 (20) | 0.92 |
Severity of coronary lesions, SYNTAX score (Me (Q25, Q75)) | 24.2 (18.5, 29.8) | 23.8 (17.8, 28.3) | 0.43 |
Operative time, min (Me (Q25, Q75)) | 200.0 (170.0, 220.0) | 210.0 (180.0, 240.0) | 0.68 |
Aortic clamping, min (Me (Q25, Q75)) | 52.5 (48.0, 59.5) | 51.0 (46.0, 60.0) | 0.36 |
CPB, min (Me (Q25, Q75)) | 78.5 (71.0, 89.0) | 82.0 (73.0, 95) | 0.27 |
Number of shunts, n (Me (Q25, Q75)) | 2.0 (2.0, 3.0) | 2.0 (2.0, 3.0) | 0.98 |
Cardioplegia infusion, n (Me (Q25, Q75)) | 2.0 (2.0, 3.0) | 2.0 (2.0, 3.0) | 0.98 |
Lowest body temperature (before CPB), °C (Me (Q25, Q75)) | 35.7 (35.3, 35.8) | 35.7 (35.3, 35.7) | 0.96 |
Lowest systolic BP, mm Hg (Me (Q25, Q75)) | 100.0 (93.0, 103.0) | 99.0 (92.0, 105.0) | 0.34 |
Intraoperative blood loss, mL (Me (Q25, Q75)) | 500.0 (400.0, 500.0) | 500.0 (400.0, 500.0) | 0.97 |
Total blood loss, mL (Me (Q25, Q75)) | 800.0 (650.0, 850.0) | 800.0 (700.0, 950.0) | 0.78 |
Parameters (Me (Q25, Q75)) | Training Group (n = 43) | Controls (n = 35) | p |
---|---|---|---|
LV EF, % | 63.0 (60.0, 67.0) | 64.0 (61.0, 66.0) | 0.96 |
LV EDV, mL | 147.5 (130.0, 173.0) | 147.0 (130.0, 180.0) | 0.24 |
LV EDD, mL | 54.0 (47.0, 74.0) | 51.0 (44.0, 62.0) | 0.23 |
LV ESV, cm | 5.5 (5.2, 5.9) | 5.5 (5.2, 6.0) | 0.31 |
LV ESD, cm | 3.6 (3.4, 4.1) | 3.5 (3.3, 3.8) | 0.47 |
VO2 peak, mL/kg/min | 15.3 (13.4, 18.3) | 15.7 (13.7, 17.1) | 0.64 |
VO2 peak, % | 59.0 (55.0, 70.0) | 63.0 (54.0, 69.0) | 0.78 |
AT, mL/kg/min | 11.9 (10.3, 14.9) | 12.5 (10.9, 15.7) | 0.24 |
AT, % | 47.5 (43.0, 59.0) | 49.5 (44.0, 62.0) | 0.15 |
Peak heart rate, bpm | 110 (98, 126) | 112 (97, 129) | 0.57 |
Exercise tolerance, W | 75.0 (75.0, 100.0) | 87.5 (75.0, 100.0) | 0.78 |
Parameters | Training Group (n = 43) | Controls (n = 35) | p |
---|---|---|---|
Combined endpoint, n (%) | 5 (11.6) | 13 (37) | 0.013 |
Myocardial infarct, n (%) | 0 | 1 (2.8) | 0.44 |
Stroke, n (%) | 1 (2.3) | 1 (2.8) | 0.56 |
Arrhythmias, n (%) | 2 (4.6) | 3 (8.5) | 0.65 |
Heart failure, n (%) | 2 (4.6) | 6 (17) | 0.13 |
Hydrothorax, n (%) | 0 | 2 (5.7) | 0.19 |
Hydropericardium, n (%) | 0 | 0 | - |
Pneumonia, n (%) | 0 | 2 (5.7) | 0.19 |
MODS, n (%) | 0 | 0 | - |
Wound complications, n (%) | 0 | 0 | - |
eGFR (CKD-EPI), mL/min/1.73 m2 (Me (Q25, Q75)) | Training Group (n = 43) | Controls (n = 35) | p |
---|---|---|---|
Baseline | 81.0 (73.0, 92.0) | 78.0 (69.0, 91.0) | 0.43 |
On the eve of CABG | 83.0 (74.0, 95.0) | 82.0 (71.0, 92.0) | 0.54 |
5–7 days after CABG | 85.0 (75.0, 99.5) | 85.0 (68.0, 97.0) | 0.78 |
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Argunova, Y.; Belik, E.; Gruzdeva, O.; Ivanov, S.; Pomeshkina, S.; Barbarash, O. Effects of Physical Prehabilitation on the Dynamics of the Markers of Endothelial Function in Patients Undergoing Elective Coronary Bypass Surgery. J. Pers. Med. 2022, 12, 471. https://doi.org/10.3390/jpm12030471
Argunova Y, Belik E, Gruzdeva O, Ivanov S, Pomeshkina S, Barbarash O. Effects of Physical Prehabilitation on the Dynamics of the Markers of Endothelial Function in Patients Undergoing Elective Coronary Bypass Surgery. Journal of Personalized Medicine. 2022; 12(3):471. https://doi.org/10.3390/jpm12030471
Chicago/Turabian StyleArgunova, Yulia, Ekaterina Belik, Olga Gruzdeva, Sergey Ivanov, Svetlana Pomeshkina, and Olga Barbarash. 2022. "Effects of Physical Prehabilitation on the Dynamics of the Markers of Endothelial Function in Patients Undergoing Elective Coronary Bypass Surgery" Journal of Personalized Medicine 12, no. 3: 471. https://doi.org/10.3390/jpm12030471