Acar Rezzan Deniz, Bulut Mustafa, Ergün Sunay, Yesin Mahmut, Boztosun Bilal, Akçakoyun Mustafa
Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
Department of Physical Therapy and Rehabilitation, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
ARYA Atheroscler. 2014 Jul;10(4):185-91.
The aim of our study was to investigate the P-wave dispersion from standard electrocardiograms (ECGs) in patients with acute myocardial infarction (AMI) after cardiac rehabilitation (CR) and determine its relation to arterial stiffness.
This is a prospective study included 33 patients with AMI and successfully re-vascularized by percutaneous coronary intervention (PCI) underwent CR. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson's method. Left atrium (LA) volume was calculated. The maximum and minimum durations of P-waves (Pmax and Pmin, respectively) were detected, and the difference between Pmax and Pmin was defined as P-wave dispersion (Pd = Pmax-Pmin). Aortic elasticity parameters were measured.
LVEF was better after CR. The systolic and diastolic blood pressures decreased after CR, these differences were statistically significant. With exercise training, LA volume decreased significantly. Pmax and Pd values were significantly shorter after the CR program. The maximum and minimum P-waves and P-wave dispersion after CR were 97 ± 6 ms, 53 ± 5 ms, and 44 ± 5 ms, respectively. Aortic strain and distensibility increased and aortic stiffness index was decreased significantly. Aortic stiffness index was 0.4 ± 0.2 versus 0.3 ± 0.2, P = 0.001. Aortic stiffness and left atrial volume showed a moderate positive correlation with P-wave dispersion (r = 0.52, P = 0.005; r = 0.64, P < 0.001, respectively).
This study showed decreased arterial stiffness indexes in AMI patient's participated CR, with a significant relationship between the electromechanical properties of the LA that may raise a question of the preventive effect of CR from atrial fibrillation and stroke in patients with acute myocardial infarction.
我们研究的目的是调查急性心肌梗死（AMI）患者在心脏康复（CR）后标准心电图（ECG）中的P波离散度，并确定其与动脉僵硬度的关系。
这是一项前瞻性研究，纳入了33例AMI患者，这些患者经皮冠状动脉介入治疗（PCI）成功再血管化后接受了CR。采用双平面辛普森法测量左心室射血分数（LVEF）。计算左心房（LA）容积。检测P波的最大和最小持续时间（分别为Pmax和Pmin），Pmax与Pmin的差值定义为P波离散度（Pd = Pmax - Pmin）。测量主动脉弹性参数。
CR后LVEF改善。CR后收缩压和舒张压下降，这些差异具有统计学意义。通过运动训练，LA容积显著减小。CR方案实施后Pmax和Pd值显著缩短。CR后的最大和最小P波以及P波离散度分别为97±6毫秒、53±5毫秒和44±5毫秒。主动脉应变和扩张性增加，主动脉僵硬度指数显著降低。主动脉僵硬度指数为0.4±0.2对比0.3±0.2，P = 0.001。主动脉僵硬度和左心房容积与P波离散度呈中度正相关（分别为r = 0.52，P = 0.005；r = 0.64，P < 0.001）。
本研究表明，参与CR的AMI患者动脉僵硬度指数降低，左心房的机电特性之间存在显著关系，这可能引发关于CR对急性心肌梗死患者房颤和中风预防作用的疑问。
