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Molecular markers of ischemia in myocardial cardioprotection assessment in physical rehabilitation programs in cardiac patients

Session Poster session 4

Speaker Nadezda Lyamina

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : N Lyamina (Saratov,RU), E Karpova (Saratov,RU), S Lyamina (Moscow,RU), E Kotelnikova (Saratov,RU), V Senchikhin (Saratov,RU), T Lipchnskaya (Saratov,RU)

N. Lyamina1 , E. Karpova1 , S. Lyamina2 , E. Kotelnikova1 , V. Senchikhin1 , T. Lipchnskaya1 , 1Saratov Scientific Research Institute of Cardiology - Saratov - Russian Federation , 2Moscow State University of Medicine and Dentistry - Moscow - Russian Federation ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 715

Use of modern molecular markers of myocardial ischemia can significantly increase the indicative level of cardioprotection effect of physical exercise (PE) in cardiorehabilitation programs. Objective: assessment of molecular markers level dynamics during short courses (10 exercises) of cardioprotective PE (CPE) with different intensity (60% and 80%) in patients with incomplete myocardial revascularization after percutaneous coronary interventions with signs of myocardial ischemia and myocardial dysfunction.

Material and methods: The open prospective study included 122 subjects with coronary artery disease after percutaneous coronary interventions with incomplete revascularization and positive results of paired stress-test with PE. Patients of group 1 (n=71) on the back of standard medical therapy performed short course (10 CPE) of daily CPE of high intensity (80%). Patients of group 2 (n=51) performed CPE of moderate intensity (60%) with the same duration. In the assessment of cardioprotective effect of CPE authors used both functional markers (maximum depression of ST, number of standard leads with ST depression >1 mm, time to ST recovery up to the initial level, ectopic activity) and molecular markers (ischemia-modified albumin (IMA), free fatty acids (FFA), brain natriuretic peptide (BNP)).

Results: After 10 days of CPE course group 1 showed 18.6% decreasing of ST level, 15.7% decreased ST index, and 1.4-fold decresing of ectopic activity. These changes were accompanied by 8.6% decreasing of IMA level (127.2±23.0 ng/ml, initially 139.6±12.0 ng/ml); in comparison group IMA was 8.4% lower (124.2±19.0 ng/ml, initially 135.6±11.3 ng/ml). The level of FFA was 13.5% (0.89 mmol/l, initially 1.03 mmol/l) lower in group 1, and 17.5% lower (0.94 mmol/l, initially 1.14%) in comparison group. The level of BNP in group 1 was 5.7% lower (45.7 pg/ml, initially 48.48 pg/ml), and 5.03% lower in comparison group (43.4 pg/ml, initially 45.7 pg/ml). In general dynamics of molecular markers changes matched with dynamics of ECG markers typical for ischemia threshold elevation.

Conclusion: Short courses of intensive (80%) daily CPE in coronary artery disease patients with incomplete myocardial revascularization are more effective in forming of cardioprotective effect of PE programs than traditional CPE of moderate intensity. Use of molecular ischemia markers reflect adequacy of selected CPE mode and this allowed timely correction of selected mode in cardiorehabilitation programs and achievement of the planned result.

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