Kim Chul, Moon Chang Jin, Lim Min Ho
Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Korea.
Ann Rehabil Med. 2012 Apr;36(2):262-7. doi: 10.5535/arm.2012.36.2.262. Epub 2012 Apr 30.
To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR.
All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9±10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%).
The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours).
Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.
调查我院心脏康复（CR）门诊10年间心脏监测运动诱发的心血管并发症，并报告早期院内CR监测运动训练的安全性。
选取2000年1月至2009年12月期间参与我院运动项目的所有心脏病患者作为研究对象。我们对心脏事件的运动风险进行分层，并根据个体化处方进行监测运动。我们测量了10年间运动训练期间所有的心脏并发症，包括死亡、症状、异常血流动力学反应和心电图（ECG）异常。本研究共纳入975例患者（男性占68%；平均年龄58.9±10.6岁）。CR的初始适应证为近期经皮冠状动脉腔内血管成形术（PTCA）（75%）、心脏手术后（冠状动脉搭桥术，13.2%）、瓣膜手术和其他心脏手术（4.2%）以及其他情况（7.6%）。
研究人群接受了13934患者小时的监测运动。运动期间未发生死亡、心脏骤停或急性心肌梗死（AMI）（0/13934运动小时）。在13934运动小时期间，59例患者发生了70次心血管事件（1/199运动小时）；仅心绞痛17例（1/820运动小时），仅ECG异常31例（1/449运动小时），心绞痛伴ECG异常12例（1/1161运动小时），异常血流动力学反应10例（1/1393运动小时）。
早期院内CR足够安全，在13934患者小时的监测运动期间未发生死亡、心脏骤停或AMI。然而，在开始监测运动之前，需要对运动诱发的心血管事件进行风险分层、制定适当的运动处方并进行强化ECG监测。
