Terashima Masato, Tamura Yuma, Takahashi Harunori, Ochiai Kaori, Ehara Kyosuke, Takahashi Momo, Otani Naoyuki, Sandor Barbara, Tomoe Takashi, Sugiyama Takushi, Ueno Asuka, Kitahara Keijiro, Kawabe Atsuhiko, Yasu Takanori
Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan.
Department of Cardiology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan.
Heart Vessels. 2025 Jan;40(1):72-85. doi: 10.1007/s00380-024-02435-0. Epub 2024 Aug 12.
This study aimed to explore the impact of cardiac rehabilitation (CR) on in vivo and ex vivo microcirculation, exercise capacity, and oxidative stress in patients with cardiovascular disease (CVD). The study included patients with acute coronary syndrome (ACS; n = 45; age, 69.0 ± 14.1 years) and heart failure (HF; n = 66; age, 77.3 ± 10.7 years) who underwent supervised CR during hospitalization. The control group comprised patients without CVD (NCVD; n = 20; age, 75.9 ± 11.2 years). In vivo microcirculatory observations using nailfold video capillary endoscopy at rest and during hyperemia, exercise capacity, and oxidative stress were assessed at baseline and 12 weeks after discharge. Baseline capillary densities were significantly lower in the ACS (5.0 ± 1.7 capillaries/mm) and HF (4.9 ± 1.7 capillaries/mm) groups than in the NCVD group (6.5 ± 1.1 capillaries/mm, p < 0.01). Similarly, capillary density during reactive hyperemia was significantly lower in the ACS (5.8 ± 1.7 capillaries/mm) and HF (5.4 ± 1.8 capillaries/mm) groups than in the NCVD group (7.3 ± 1.4 capillaries/mm, p < 0.01). Patients with ACS and HF had increased capillary densities at 12 weeks compared with at baseline (p < 0.05). This improvement was particularly pronounced among post-discharge outpatient CR participants (n = 20). Grip strength, exercise capacity, and oxidative stress improved at 12 weeks. Baseline capillary density changes were positively correlated with grip strength changes (r = 0.45, p < 0.001). CR significantly improved nailfold capillary density in patients with ACS and HF 12 weeks after discharge.
本研究旨在探讨心脏康复（CR）对心血管疾病（CVD）患者体内和体外微循环、运动能力及氧化应激的影响。该研究纳入了在住院期间接受有监督的CR的急性冠状动脉综合征（ACS；n = 45；年龄，69.0±14.1岁）和心力衰竭（HF；n = 66；年龄，77.3±10.7岁）患者。对照组包括无CVD的患者（NCVD；n = 20；年龄，75.9±11.2岁）。在静息和充血状态下使用甲襞视频毛细血管内镜进行体内微循环观察，并在基线和出院后12周评估运动能力及氧化应激。ACS组（5.0±1.7条毛细血管/mm）和HF组（4.9±1.7条毛细血管/mm）的基线毛细血管密度显著低于NCVD组（6.5±1.1条毛细血管/mm，p < 0.01）。同样，反应性充血期间的毛细血管密度在ACS组（5.8±1.7条毛细血管/mm）和HF组（5.4±1.8条毛细血管/mm）也显著低于NCVD组（7.3±1.4条毛细血管/mm，p < 0.01）。与基线相比，ACS和HF患者在12周时毛细血管密度增加（p < 0.05）。这种改善在出院后门诊CR参与者（n = 20）中尤为明显。握力、运动能力及氧化应激在12周时有所改善。基线毛细血管密度变化与握力变化呈正相关（r = 0.45，p < 0.001）。CR显著改善了ACS和HF患者出院后12周的甲襞毛细血管密度。
