Effect of cardiac rehabilitation on mortality related inflammatory markers

Abstract

Aim: Cardiac Rehabilitation (CR) is a rehabilitation method which decreases mortality in cardiac patients. The main goal of this study is to investigate the effect of CR on neutrophil-to-lymphocyte ratio (NLR) and thrombocyte-to-lymphocyte ratio (TLR), which are inflammatory markers directly related to mortality in cardiac patients. The secondary goal is to assess the effect of CR on functional capacity.

Methods: This retrospective cohort study consists of 211 CR patients who completed 30 sessions of tailored comprehensive CR programs. Their functional status and cardiovascular endurance were assessed with a 6- minute walk test and a cycle ergometer test. Inflammatory markers (TLR, NLR, sedimentation, CRP) were obtained from blood testing and demographic data were collected. After 30 sessions of CR all tests were repeated. No adverse events occurred during the exercise sessions.

Results: Among 211 patients enrolled in this the study, 114 (%54) were female and 97 (%46) were male. Mean age was 56.28 (10.25) years (min 21 - max 81 years). 94 (%44.5) patients were hypertensive, 24 (%11.4) had heart failure, 83 (%39.3) had coronary artery disease and 10 (%4.7) had arrhythmia. Mean range for the 6-minute walk test was 374.62 (61.75) meters before and 390.80 (62.87) meters after CR (P<0.001). Mean values of the maximum watts in cycle ergometer effort test were 50 watts before and 75 watts after CR (P<0.001). Before and after CR, NLR and TLR were 1.6, 1.4 and 107.59 (35.22), 101.46 (32.78), respectively (P<0.001). Sedimentation and CRP levels were 22.38 (11.55) mm/hour, 1.0 mg/dl before and 18.98 (10.06) mm/hour, 0.5 md/dl after rehabilitation, respectively (P<0.001).

Conclusion: CR can decrease the inflammatory markers TLR and NLR which are directly related to mortality in cardiac patients, while increasing the patients’ functional capacity.

Keywords

• Cardiac rehabilitation,Inflammation,Mortality

Egzersiz temelli kardiyak rehabilitasyonun mortalite ilişkili inflamatuar belirteçlere etkisi

Öz

Amaç: Kardiyak rehabilitasyon kalp hastalarında mortaliteyi azaltan bir rehabilitasyon metodudur fakat bu etkisinin hangi parametreler üzerinden olduğuyla ilgili netlik yoktur. Nötrofil lenfosit ve trombosit lenfosit oranı kalp hastalarında mortaliteyle direk ilişkili inflamatuar belirteçlerdir. Bu çalışmanın amacı kardiyak rehabilitasyonun kalp hastalarında mortaliteyle direk ilişkili olan inflamatuar belirteçler (nötrofil lenfosit oranı, trombosit lenfosit oranı) üzerine olan etkilerini araştırmaktır. Çalışmanın ikincil hedefi ise kardiyak rehabilitasyonun aynı hasta grubunda fonksiyonel kapasite üzerine etkisini araştırmaktır.

Yöntemler: Bu çalışmaya 30 seans kardiyak rehabilitasyon programını tamamlayan 211 hasta dahil edilmiştir. Öncelikle hastaların fonksiyonel durumları 6 dakika yürüme testiyle, kardiyovasküler dayanıklılıkları bisiklet ergometer efor testi ile değerlendirilmiş, inflamatuar markerları (nötrofil lenfosit oranı, trombosit lenfosit oranı, sedimentasyon, CRP) kan testiyle bakılmış, demografik özellikleri kaydedilmiştir. 30 seans kardiyak rehabilitasyon sonrası bütün testler tekrar edilmiş ve istatistiksel analizleri yapılmıştır. Egzersiz seansları süresince herhangi bir yan etki gözlenmemiştir. Retrospektif bir kohort çalışmasıdır. 

Bulgular: Bu çalışmaya 211 hasta alınmıştır. Hastaların 114’ü (%54) kadın ve 97’si (%46) erkektir. Ortalama yaş 56,28 (10,25) yaştır (minimum 21 - maksimum 81 yaş). 94 (%44,5) hastada hipertansiyon, 24 (%11,4) hastada kalp yetmezliği, 83 (%39,3) hastada coroner arter hastalığı ve 10 (%4,7) hastada aritmi mevcuttu. 6 dakika yürüme testinde kardiyak rehabilitasyon öncesi ortalama mesafe 374,62 (61,75) metre olup rehabilitasyon sonrası bu mesafe 390,80 (62,87) metreye çıkmıştır (P<0,001). Bisiklet ergometer efor testinin maksimum watt ortalama değeri tedavi öncesi 50 watt iken tedavi sonrası 75 watt olmuştur (P<0,001). Nötrofil lenfosit oranı tedavi öncesi 1,6 iken tedavi sonrası 1,4 olarak saptanmıştır; trombosit lenfosit oranı ise rehabilitasyon öncesi 107,59 (35,22) iken rehabilitasyon sonrası 101,46 (32,78) olarak saptanış olup her ikiside istatistiksel olarak anlamlıdır (P<0,001). Sedimentasyon ve CRP düzeyleri rehabilitasyon öncesi sırasıyla; 22,38 (11,55) mm/saat, 1,0 mg/dl iken rehabilitasyon sonrası, 18,98 (10,06) mm/saat ve 0,5 md/dl olarak değişmiştir (P<0,001).

Sonuç: Kardiyak rehabilitasyon mortaliteyle direk ilişkili belirteçler olan nötrofil lenfosit oranını ve trombosit lenfosit oranını düşürür ve aynı zamanda hastaların fonksiyonel kapasitelerini artırır.

Anahtar Kelimeler

• Kardiyak rehabilitasyon,İnflamasyon,Mortalite

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