Silber Taryn C, Tweet Marysia S, Bowman Melissa J, Hayes Sharonne N, Squires Ray W
William Beaumont School of Medicine, Oakland University, Rochester, Michigan (Ms Silber); and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Ms Silber, Dr Tweet, Ms Bowman, Dr Hayes, and Dr Squires).
J Cardiopulm Rehabil Prev. 2015 Sep-Oct;35(5):328-33. doi: 10.1097/HCR.0000000000000111.
Although cardiac rehabilitation (CR) improves outcomes in patients after atherosclerotic myocardial infarctions, little is known of the CR benefit among patients with spontaneous coronary artery dissection (SCAD), who are primarily young, otherwise healthy women. The purpose of this study was to describe SCAD patient outcomes in phase 2 outpatient CR.
Patients with SCAD who enrolled in CR were retrospectively identified. Patients participated in standard CR, which included supervised and independent flexibility, stretching, aerobic, and strength training exercises. Patients received counseling regarding nutrition, weight and stress management. Assessments at baseline and program completion included cardiopulmonary exercise testing or 6-Minute Walk Test, body composition using plethysmography, depression (Patient Health Questionnaire-9), and stress (a scale of 1-10) scores.
Nine patients, all women, enrolled in CR an average of 12.3 days (range, 7-21 days) after their SCAD event, with one enrolling again after a recurrence. Cardiac rehabilitation was well received, with participants completing an average of 28 CR sessions (range, 5-39 sessions). Patients did not report cardiac symptoms and there were no adverse events during exercise testing or training. Peak oxygen uptake increased by an average of 18% (n = 4) and 6-minute walk distance increased 22% (n = 4). Average body mass decreased 1.1 kg, fat mass decreased 1.6 kg, and lean mass increased 0.4 kg. Depression and stress scores improved by an average of 2.3 and 1.3 points, respectively.
Standard CR beginning 1 to 2 weeks after SCAD seems to be feasible and safe and results in improved aerobic capacity, body composition, and measures of depression and stress. Because of these benefits, we recommend that patients with SCAD participate in CR.
尽管心脏康复（CR）可改善动脉粥样硬化性心肌梗死后患者的预后，但对于主要为年轻、其他方面健康的女性自发性冠状动脉夹层（SCAD）患者，心脏康复的益处知之甚少。本研究的目的是描述SCAD患者在第二阶段门诊心脏康复中的预后情况。
对纳入心脏康复的SCAD患者进行回顾性识别。患者参加标准的心脏康复，包括有监督和自主的柔韧性、伸展、有氧运动和力量训练。患者接受了关于营养、体重和压力管理的咨询。基线和项目完成时的评估包括心肺运动测试或6分钟步行测试、使用体积描记法测量身体成分、抑郁（患者健康问卷-9）和压力（1-10分制）评分。
9名患者均为女性，在SCAD事件后平均12.3天（范围7-21天）参加心脏康复，其中1名患者复发后再次参加。心脏康复受到好评，参与者平均完成28次心脏康复课程（范围5-39次）。患者未报告心脏症状，运动测试或训练期间未发生不良事件。峰值摄氧量平均增加18%（n = 4），6分钟步行距离增加22%（n = 4）。平均体重下降1.1 kg，脂肪量下降1.6 kg，瘦体重增加0.4 kg。抑郁和压力评分分别平均改善2.3分和1.3分。
SCAD后1至2周开始的标准心脏康复似乎可行且安全，并可改善有氧运动能力、身体成分以及抑郁和压力指标。鉴于这些益处，我们建议SCAD患者参加心脏康复。
