Rehabilitation of patients with myocardial revascularization:: prognostic significance of cardiopulmonary exercise test

Kardiovaskularne bolesti (KVB) su vodeći uzrok smrti, kako u svetu tako i u našoj zemlji. Od svih KVB, najčešća je koronarna bolest srca koja je udružena sa najvećom stopom morbiditeta i mortaliteta do 25%. Kardiološka rehabilitacija (CR, od engl. Cardiac Rehabilitation) je skup aktivnosti i intervencija potrebnih za postizanje najboljeg mogućeg fizičkog, mentalnog i socijalnog stanja pacijenata sa KVB. Cilj: Ispitati uticaj i efekat tronedeljnog programa CR na poboljšanje funkcionalnog kapaciteta procenjenog CPET-om (od engl. Cardio Pulmonary Exercise Testing) i proceniti održivost efekata u periodu od šest meseci od okončanja programa CR kod pacijenata nakon perkutane i hirurške revaskularizacije miokarda. Metode: U ovoj studiji je uključeno 120 pacijenata (111 muškaraca, prosečne starosti 54,90 ± 8,80 i 9 žena, prosečne starosti 55,70 ± 5,20) podeljenih u III grupe. Grupa I koju je činilo 40 pacijenta (38 muškaraca i 2 žene) lečenih CABG (od engl. Coronary Artery Bypass Grafting). Grupa II koju je činilo 40 pacijenta (39 muškaraca i 1 žena) lečenih PCI (od engl. Percutaneous Coronary Intervention). Grupa III koju je činilo 40 pacijenta (34 muškaraca i 6 žena) lečenih Ele.PCI (od engl. Elective Percutaneous Coronary Intervention). Fizički trening se sastojao od dve trening sesije. Prve jutarnje sesije trajanja do 60 minuta sa aerobnim intervalnim treningom (3 minuta treninga i 3 minuta odmora) na biciklergometru. Kao i hoda preko Nyllinovog stepenika. Sesija je sadržala: vežbe zagrevanja 10 minuta, trening fazu trajanja do 45 minuta i potom fazu 5-to minutnog hlađenja. Druga, popodnevna sesija, koncipirana je od hoda po ravnom brzinom 3 do 5 km na čas (kontinuirani trening). Trajanje ove sesije je bilo individualno i svakodnevno je povećavano. Svim pacijentima I i II grupe posle tronedeljnog hospitalnog programa CR savetovan je program aerobnog fizičkog treninga koji se sastojao od šetnji brzinom 5 km/h, u trajanju od 60 min, 3-5 puta nedeljno, ciljanog intenziteta od 70% do 85% maksimalne srčane frekvence postignute na CPET-u nakon tronedeljnog programa hospitalne CR, koji su oni, uz vođenje dnevnika, sprovodili u trajanju od šest meseci kod kuće...Cardiovascular diseases (CVD) are the leading cause of death in the world and in our country. From all CVD, the most common is coronary heart disease which is associated with the highest morbidity and mortality by 25%. Cardiac rehabilitation (CR) is a set of activities and interventions needed to achieve the best possible physical, mental and social condition of patients with CVD. Aim: To examine the impact and effect of the three-week CR program to improve functional capacity estimated with CPET (Cardio Pulmonary Exercise Testing) and assess the sustainability of the effects of a period of six months from the end of the CR program in patients after percutaneous and surgical revascularization of myocardium. Methods: This study included 120 patients (111 males, mean age 54.90 ± 8.80 and 9 female, mean age 55.70 ± 5.20) who were divided into three groups. Group I consisted of 40 patients (38 men and 2 women) treated with CABG (Coronary Artery Bypass Grafting). Group II consisted of 40 patients (39 men and 1 women), treated with PCI (Percutaneous Coronary Intervention). Group III consisted of 40 patients (34 men and 6 women) treated with Ele.PCI (Elective Percutaneous Coronary Intervention). Physical training consisted of two training sessions. First morning sessions lasting up to 60 minutes with aerobic training interval (the training 3 minutes and 3 minutes of rest) on the ergo cycle. As an and walk through the Nyllin stairs. A session is contained of the: warm-up exercises for 10 min, a training phase of 45 minutes duration, and then 5 minute cooling phase. The second afternoon session, conceived by walking on a flat rate of 3 to 5 km per hour (continuous training). The duration of this session is an individual, and every day is increased. For all patients from first and the second group after a three-week hospital CR program, aerobic exercise training program is advised, consisting of a walking speed of 5 km/h, for 60 min, 3-5 times a week, a target intensity of 70% to 85% from maximum heart frequency achieved on CPET, which they, along with keeping a journal, conducted for a period of six months at home. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 W/minute..