Lee Jae-Hwan, Kim Jungai, Sun Byung Joo, Jee Sung Ju, Park Jae-Hyeong
Division of Cardiology in Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong 30099, Korea.
Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, Korea.
J Clin Med. 2021 May 13;10(10):2088. doi: 10.3390/jcm10102088.
Cardiac rehabilitation (CR) improves symptoms and survival in patients with acute myocardial infarction (AMI). We studied the change of diastolic function and its prognostic impact after CR. After reviewing all consecutive AMI patients from January 2012 to October 2015, we analyzed 405 patients (mean, 63.7 ± 11.7 years; 300 males) with baseline and follow-up echocardiographic examinations. We divided them into three groups according to their CR sessions: No-CR group ( = 225), insufficient-CR group (CR < 6 sessions, = 117) and CR group (CR ≥ 6 sessions, = 63). We compared echocardiographic parameters of diastolic dysfunction including E/e' ratio > 14, septal e' velocity < 7 cm/s, left atrial volume index (LAVI) > 34 mL/m, and maximal TR velocity > 2.8 m/s. At baseline, there were no significant differences in all echocardiographic parameters among the three groups. At follow-up echocardiographic examination, mitral annular e' and a' velocities were higher in the CR group ( = 0.024, and = 0.009, respectively), and mitral E/e' ratio was significantly lower ( = 0.009) in the CR group. The total number of echocardiographic parameters of diastolic dysfunction at the baseline echocardiography was similar (1.29 vs. 1.41 vs. 1.52, = 0.358). However, the CR group showed the lowest number of diastolic parameters at the follow-up echocardiography (1.05 vs. 1.32 vs. 1.50, = 0.017). There was a significant difference between the No-CR group and CR group ( = 0.021). The presence of CR was a significant determinant of major adverse cardiovascular events in the univariate analysis (HR = 0.606, = 0.049). However, the significance disappeared in the multivariate analysis (HR = 0.738, = 0.249). In conclusion, the CR was significantly associated with favorable diastolic function, with the highest mitral e' and a' velocity, and the lowest mitral E/e' ratio and total number of echocardiographic parameters of diastolic dysfunction at the follow-up echocardiographic examinations in AMI patients.
心脏康复（CR）可改善急性心肌梗死（AMI）患者的症状并提高生存率。我们研究了CR后舒张功能的变化及其预后影响。在回顾了2012年1月至2015年10月期间所有连续的AMI患者后，我们分析了405例患者（平均年龄63.7±11.7岁；男性300例），这些患者均进行了基线和随访超声心动图检查。我们根据他们的CR疗程将他们分为三组：无CR组（=225）、CR不足组（CR<6个疗程，=117）和CR组（CR≥6个疗程，=63）。我们比较了舒张功能障碍的超声心动图参数，包括E/e'比值>14、室间隔e'速度<7cm/s、左心房容积指数（LAVI）>34mL/m²以及最大三尖瓣反流速度>2.8m/s。在基线时，三组之间所有超声心动图参数均无显著差异。在随访超声心动图检查时，CR组的二尖瓣环e'和a'速度较高（分别为P=0.024和P=0.009），且CR组的二尖瓣E/e'比值显著较低（P=0.009）。基线超声心动图检查时舒张功能障碍的超声心动图参数总数相似（1.29对1.41对1.52，P=0.358）。然而，CR组在随访超声心动图检查时舒张参数数量最低（1.05对1.32对1.50，P=0.017）。无CR组和CR组之间存在显著差异（P=0.021）。在单因素分析中，CR的存在是主要不良心血管事件的显著决定因素（HR=0.606，P=0.049）。然而，在多因素分析中该显著性消失（HR=0.738，P=0.249）。总之，在AMI患者的随访超声心动图检查中，CR与良好的舒张功能显著相关，具有最高的二尖瓣e'和a'速度，以及最低的二尖瓣E/e'比值和舒张功能障碍的超声心动图参数总数。
