Effect of cardiac rehabilitation exercise on ventricular remodeling in patients with acute myocardial infarction undergoing percutaneous coronary intervention / 中国基层医药

ABSTRACT

Objective:To investigate the therapeutic effect of cardiac rehabilitation exercise on ventricular remodeling in patients with acute myocardial infarction undergoing percutaneous coronary intervention.Methods:A total of 100 patients with acute myocardial infarction undergoing percutaneous coronary intervention who received treatment in Wenzhou Central Hospital from June 2018 to June 2019 were included in this study. They were randomly divided into a rehabilitation group and a conventional treatment group ( n = 50/group). Patients in the conventional treatment group underwent conventional postoperative rehabilitation education while those in the rehabilitation group received targeted cardiac rehabilitation exercise. After surgery, all patients were followed up for 12 months. Real time three-dimensional echocardiography was used to evaluate ventricular remodeling (left ventricular ejection fraction, left ventricular end-diastolic volume , left ventricular end-systolic volume, left ventricular remodeling index) and ventricular synchrony (Tmsv-16dif, Tmsv-16sd, Tmsv16-dif%, Tmsv16-sd%) before and 3, 6 and 12 months after surgery. In addition, serum levels of ventricular remodeling indexes (fibroblast growth factor 23, PICP and PIIINP) were measured. The incidence of cardiovascular end-point events within 12 months was calculated. Results:At 3, 6 and 12 months after surgery, left ventricular ejection fraction was (51.81 ± 5.43)%, (55.88 ± 5.46)%, (55.63 ± 5.57)% in the rehabilitation group, which was significantly higher than (47.16 ± 5.38)%, (52.31 ± 5.44)%, (51.84 ± 5.59)% respectively in the conventional treatment group ( t = 4.302, 3.275, 3.396, all P < 0.05). At 3, 6 and 12 months after surgery, left ventricular end-diastolic volume was (124.65 ± 15.56) mL, (98.54 ± 14.54) mL, (99.82 ± 13.18) mL, respectively in the rehabilitation group, which was lower than (132.64 ± 16.58) mL, (112.55 ± 15.61) mL and (114.84 ± 17.35) mL, respectively in the conventional treatment group ( t = 2.485, 4.644, 4.874, all P < 0.05). At 6 and 12 months after surgery, left ventricular end-systolic volume was (52.26 ± 5.48) mL and (52.15 ± 5.32) mL respectively in the rehabilitation group, which was significantly lower than (57.92 ± 5.46) mL and (58.51 ± 5.72) mL in the conventional treatment group ( t = 5.174, 5.757, both P < 0.05). At 6 and 12 months after surgery, left ventricular remodeling index was (1.75 ± 0.42) g/mL and (1.74 ± 0.35) g/mL respectively in the rehabilitation group, which was significantly higher than (1.52 ± 0.37) g/mL and (1.50 ± 0.32) g/mL, respectively in the conventional treatment group ( t = 2.906, 3.579, both P < 0.05). At 3, 6 and 12 months after surgery, Tmsv-16dif ( t = 2.753, 4.283, 4.088, all P < 0.05), Tmsv-16sd ( t = 5.134, 4.326, 4.670, all P < 0.05), Tmsv-16dif% ( t = 7.714, 8.587, 7.800, all P < 0.05) and Tmsv16-sd% ( t = 9.004, 14.061, 10.305, all P < 0.05) respectively in the rehabilitation group, were significantly lower than those in the conventional treatment group. At 3, 6 and 12 months after surgery, fibroblast growth factor 23 ( t = 6.303, 5.053, 4.619, all P < 0.05). PICP ( t = 3.772, 2.798, 3.788, all P < 0.05) and PIIINP ( t = 3.110, 5.912, 4.294, all P < 0.05) in the rehabilitation group were significantly lower than those in the conventional treatment group. Within 12 months, the total incidence of cardiovascular end-point events in the rehabilitation group [12.00% (6/50)] was significantly lower than that in the conventional treatment [32.00% (16/50)] ( χ2 = 5.828, P < 0.05). Conclusion:Cardiac rehabilitation exercise can improve ventricular remodeling and synchrony in patients with acute myocardial infarction undergoing percutaneous coronary intervention and reduce the incidence of cardiovascular end-point events.