Lee K W, Blann A D, Jolly K, Lip G Y H
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK.
Heart. 2006 Dec;92(12):1732-8. doi: 10.1136/hrt.2006.092163. Epub 2006 Jun 28.
Cardiac rehabilitation is an accepted therapeutic intervention in patients after myocardial infarction or coronary revascularisation. The effects of cardiac rehabilitation programmes, whether home based or hospital based, on haemostatic indices (as reflected by fibrinogen, plasma viscosity, fibrin D-dimer (an index of thrombogenesis), von Willebrand factor (vWf, an index of endothelial damage/dysfunction), soluble P-selectin (an index of platelet activation)), vasomotor function (using flow-mediated dilatation (FMD)) and ambulatory blood pressure (ABP) in patients with coronary heart disease are unknown.
81 patients (66 men, mean (SD) 59 (11) years) after myocardial infarction or coronary revascularisation were randomised to comprehensive hospital-based (n = 40) or home-based (n = 41) cardiac rehabilitation. Plasma levels of vWf, D-dimer, fibrinogen, soluble P-selectin and plasma viscosity, as well as FMD and 24-h ABP, were measured at baseline and after 3 months of cardiac rehabilitation.
In patients who completed cardiac rehabilitation, levels of vWf, fibrinogen and D-dimer were significantly lower and FMD improved (all p<or=0.001), whereas levels were unchanged in controls. Significant reductions were also observed in 24-h mean systolic blood pressure, diastolic blood pressure and mean aortic pressure after completion of cardiac rehabilitation (all p<0.05). No significant differences were observed between the hospital-based and home-based cardiac rehabilitation programmes on these indices.
Cardiac rehabilitation improves haemostasis, endothelial function and ABP in patients with coronary heart disease, with no significant differences between home-based and hospital-based cardiac rehabilitation programmes. These effects may contribute to the beneficial effects of cardiac rehabilitation programmes on CV outcomes.
心脏康复是心肌梗死或冠状动脉血运重建术后患者公认的治疗干预措施。心脏康复计划，无论是基于家庭还是基于医院的，对冠心病患者止血指标（以纤维蛋白原、血浆粘度、纤维蛋白D - 二聚体（血栓形成指标）、血管性血友病因子（vWf，内皮损伤/功能障碍指标）、可溶性P - 选择素（血小板活化指标）反映）、血管舒缩功能（采用血流介导的血管舒张（FMD））和动态血压（ABP）的影响尚不清楚。
81例心肌梗死或冠状动脉血运重建术后患者（66例男性，平均（标准差）年龄59（11）岁）被随机分为综合医院心脏康复组（n = 40）或家庭心脏康复组（n = 41）。在基线和心脏康复3个月后测量vWf、D - 二聚体、纤维蛋白原、可溶性P - 选择素的血浆水平以及血浆粘度、FMD和24小时ABP。
完成心脏康复的患者中，vWf、纤维蛋白原和D - 二聚体水平显著降低，FMD改善（均p≤0.001），而对照组水平无变化。心脏康复完成后，24小时平均收缩压、舒张压和平均主动脉压也显著降低（均p < 0.05）。在这些指标上，基于医院和基于家庭的心脏康复计划之间未观察到显著差异。
心脏康复可改善冠心病患者的止血、内皮功能和ABP，基于家庭和基于医院的心脏康复计划之间无显著差异。这些作用可能有助于心脏康复计划对心血管结局产生有益影响。
