Mendes Renata Gonçalves, Simões Rodrigo Polaquini, Costa Fernando de Souza Melo, Pantoni Camila Bianca Falasco, Di Thommazo-Luporini Luciana, Luzzi Sérgio, Amaral-Neto Othon, Arena Ross, Catai Aparecida Maria, Borghi-Silva Audrey
Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of Sao Carlos , Sao Paulo , Brazil .
Disabil Rehabil. 2014;36(2):155-62. doi: 10.3109/09638288.2013.782362. Epub 2013 May 7.
To assess whether the same exercise-based inpatient program applied to patients with normal and reduced left ventricular function (LVF) evokes a similar cardiac autonomic response after coronary artery bypass graft (CABG).
Forty-four patients post-CABG, subgrouped according to normal LVF [LVFN: n = 23; left ventricular ejection fraction (LVEF) ≥ 55%] and reduced LVF (LVFR: n = 21; LVEF 35-54%), were included. All initiated the exercise protocol on post-operative day 1 (PO1), following a whole progressive program until discharge. Cardiac autonomic response was assessed by the indices of heart rate variability (HRV) at rest and during exercise (extremity range of motion and ambulation).
During ambulation, lower values of HRV indices were found in the LVFR group compared with the LVFN group [standard deviation of all RR (STDRR; 6.1 ± 2.7 versus 8.9 ± 4.7 ms), baseline width of the RR histogram (TINN; 30.6 ± 14.8 versus 45.8 ± 24.9 ms), SD2 (14.8 ± 8.0 versus 21.3 ± 9.0 ms), Shannon entropy (3.6 ± 0.5 versus 3.9 ± 0.4) and correlation dimension (0.08 ± 0.2 versus 0.2 ± 0.2)]. Also, when comparing the ambulation to rest change, lower values were observed in the LVFR group for linear (STDRR, TINN, RR TRI, rMSSD) and non-linear (SD2 and correlation dimension) HRV indices (p < 0.05). On PO1, we observed only intra-group differences between rest and exercise (extremity range of motion), for mean intervals between heart beats and heart rate.
For patients with LVFN, the same inpatient exercise protocol triggered a more attenuated autonomic response compared with patients with LVFR. These findings have implications as to how exercise should be prescribed according to LVF in the early stages following recovery from CABG. Implications for Rehabilitation Exercise-based inpatient program, performed by post-CABG patients who have normal left ventricular function, triggered a more attenuated cardiac autonomic response compared with patients with reduced left ventricular function. Volume of the inpatient exercises should be prescribed according to the left ventricular function in the early stages following recovery from CABG.
评估应用于左心室功能正常和降低的患者的相同的基于运动的住院治疗方案在冠状动脉旁路移植术（CABG）后是否会引发相似的心脏自主神经反应。
纳入44例CABG术后患者，根据左心室功能正常[左心室功能正常组（LVFN）：n = 23；左心室射血分数（LVEF）≥55%]和左心室功能降低（左心室功能降低组（LVFR）：n = 21；LVEF 35 - 54%）进行分组。所有患者均在术后第1天（PO1）开始运动方案，遵循整个渐进性方案直至出院。通过静息和运动期间（肢体活动范围和步行）的心率变异性（HRV）指标评估心脏自主神经反应。
在步行期间，LVFR组的HRV指标值低于LVFN组[所有RR间期的标准差（STDRR；6.1±2.7对8.9±4.7毫秒），RR间期直方图的基线宽度（TINN；30.6±14.8对45.8±24.9毫秒），SD2（14.8±8.0对21.3±9.0毫秒），香农熵（3.6±0.5对3.9±0.4）和关联维数（0.08±0.2对0.2±0.2）]。此外，比较步行与静息变化时，LVFR组的线性（STDRR、TINN、RR三角指数、rMSSD）和非线性（SD2和关联维数）HRV指标值较低（p < 0.05）。在PO1时，我们仅观察到静息和运动（肢体活动范围）之间的组内差异，涉及平均心跳间期和心率。
对于LVFN患者，与LVFR患者相比，相同的住院运动方案引发的自主神经反应更弱。这些发现对于CABG恢复后的早期阶段如何根据左心室功能制定运动方案具有启示意义。康复启示基于运动的住院治疗方案，由左心室功能正常的CABG术后患者执行，与左心室功能降低的患者相比，引发的心脏自主神经反应更弱。CABG恢复后的早期阶段，应根据左心室功能制定住院运动的量。
