KORONER ARTER BYPASS GREFT CERRAHİSİ SONRASI KARDİYOPULMONER REHABİLİTASYON VE NÖROMÜSKÜLER ELEKTRİK STİMÜLASYONUN FONKSİYONEL KAPASİTE, MİYOKARDİAL DOKU DOPPLERİ ÜZERİNDEKİ KISA DÖNEM ETKİLERİ

Year 2022, Volume: 33 Issue: 2, 32 - 44, 20.08.2022

Burcu Özüberk , Zuhal Kunduracılar , Ummuhan Baş Aslan , Sıtkı Turan , Mustafa Ozan Çakır , Ufuk Tütün

https://doi.org/10.21653/tjpr.951439

Cited By: 1

Abstract

Amaç: Egzersiz kapasitesi diyastolik fonksiyonla ilişkilidir. Çalışmamızın amacı, koroner arter cerrahisi sonrası kardiyopulmoner rehabilitasyon ve NMES'in fonksiyonel kapasite ve miyokard doku doppleri (MDD) üzerine kısa dönem etkilerini araştırmaktır.
Yöntemler: Koroner arter baypas greftli kırk hasta rastgele iki gruba ayrıldı: CPR+NMES ve CPR. Fonksiyonel kapasite 2 dakika yürüme testi (2DYT) ve otur kalk testi (SST), sol ventrikül diyastolik (LV) fonksiyonları MDD ile, göğüs ekspansiyonu göğüs duvarı ölçümü ile postoperatif 2. ve 7. günlerde analiz edildi.
Sonuçlar: Gruplar arasında, 2DYTmesafe (CPR+NMES, Zt*p=0,000*), SST (CPR, Zt*p=0,000*), E’ (CPR+NMES, Zt*p=0,002*), E (CPR+NMES, Zt*p=0,025*), E/E’ (CPR+NMES, Zt*p=0,007*), A (CPR, Zt*p=0,006*) istatistiksel olarak anlamlı fark tanımlanmıştır (p<0,05). Grup içi karşılaştırmalarda E’ (CPR+NMES, G*p=0,000*) ve E/E’ (CPR+NMES, G*p=0,007* postoperatif 2. gün; G*p=0,019* postoperatif 7.gün) istatistiksel olarak anlamlı fark gözlenmiştir (p<0,05). E' (Zg*p=0,000*), E/E' (Zg*p=0,003*) parametreleri hariç (p<0,05), 2DYT mesafe, kalp hızı, kan basıncı, solunum frekansı, saturasyon ve Borg dispne-yorgunluk ölçümleri zamana göre gruplar arasında istatistiksel farklılık göstermedi (p>0,05).
Tartışma: Erken dönem kardiyopulmoner rehabilitasyona ek olarak uyguladığımız NMES'in, CPR + NMES grubundaki LV dolum basıncına ve LV dolum hızına olumlu bir katkı yaptığı görülmüştür. Ayrıca CPR + NMES grubunun gruplar arası karşılaştırmalarında, postoperatif 7. günde postoperatif 2. güne kıyasla 2DYT mesafesinde istatistiksel olarak anlamlı bir artış olduğu görülmüştür.

Keywords

Kardiyopulmoner Rehabilitasyon, Koroner Arter Baypas Greft, Fonksiyonel Kapasite, NMES, Doku Doppleri

Supporting Institution

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Project Number

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Thanks

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SHORT TERM EFFECTS OF CARDIOPULMONARY REHABILITATION AND NEUROMUSCULAR ELECTRICAL STIMULATION ON FUNCTIONAL CAPACITY, MYOCARDIAL TISSUE DOPPLER AFTER CORONARY ARTERY BYPASS GRAFT SURGERY

Abstract

Purpose: Exercise capacity is associated with diastolic function. The aim of our study is to investigate the short term effects of cardiopulmonary rehabilitation and NMES on functional capacity and myocardial tissue doppler (MTD) after coronary artery surgery.
Methods: Forty patients with coronary artery bypass graft were randomly divided into two groups: CPR+NMES and CPR. Functional capacity were analyzed through 2 minutes walk test (2MWT) and sit to stand test (SST), left ventricular (LV) diastolic functions were analyzed with MTD and thoracic expansion was analyzed with chest wall measurement on the 2nd and 7th postoperative days.
Results: Statistically significant difference was identified between the groups in 2MWT distance (CPR+NMES, Zt*p=0.000*), SST (CPR, Zt*p=0.000*), E’ (CPR+NMES, Zt*p=0.002*), E (CPR+NMES, Zt*p=0.025*), E/E’ (CPR+NMES, Zt*p=0.007*), A (CPR, Zt*p=0.006*) (p<0.05). Statistically significant difference has been observed in group comparisons in E’ (CPR+NMES, G*p=0.000*) ve E/E’(CPR+NMES, G*p=0.007* postoperative 2nd day; G*p=0.019* postoperative 7th day) (p<0.05). The temporal changes of 2MWT distance, heart rate, blood pressures, respiratory frequency, saturation and Borg dyspnea-fatigue measurements did not show a statistically significant difference between groups (p>0.05), except for E'(Zg*p=0.000*), E/E' (Zg*p=0.003*) parameters (p<0.05).
Conclusion: It was seen that NMES, which we applied in addition to early cardiopulmonary rehabilitation, made a positive contribution to LV filling pressure and LV filling rate in the CPR+NMES group. Additionally, in the intergroup comparisons of the CPR+NMES group, it was observed that there was a statistically significant increase in the 2 MWT distance on the postoperative 7th day compared to the postoperative 2nd day.

Keywords

Cardiopulmonary Rehabilitation, Coronary Artery Bypass Graft, Functional Capacity, NMES, Tissue Doppler

Project Number

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References

• 1- Carvalho AR, Sousa IM. Physiotherapeutic intervention in the postoperative period of myocardial revascularization: systematic review. J Physiother Res. 2020;10(3):543-552.
• 2- Smart NA, Dieberg G, Giallauria F. Functional electrical stimulation for chronic heart failure: a meta-analysis. Int J Cardiol. 2013; 167 (1): 80-86.
• 3- Nuhr MJ, Pette D, Berger R, Quittan M, Grevenna R, Huelsman M, et al. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J 2004; 25: 136–143.
• 4- Pinamonti B, Zecchin M, diLenarda A, Gregori D, Sinagra G, Camerini F. Persistence of restrictive LVfilling pattern in dilated cardiomyopathy: An ominous prognostic sign. J Am Coll Cardiol 1997; 29: 604 – 612.
• 5- Masuyama T, Yamamoto K, Sakata Y, Doi R, Nishikawa H, Kondo H, et al. Evolving changes in Doppler mitral flow velocity pattern in rats with hypertensive hypertrophy. J Am Coll Cardiol 2000; 36:2333 – 2338.
• 6- Oh JK, Hatle L, Tajik AJ, Little WC: Diastolic heart failure can be diagnosed by comprehensve two-dimensional and Doppler echocardiography. J Am Coll Cardiol. 2006; 47; 500.
• 7- Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28:2539 –50.
• 8- Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD, Houston, Texas; Oslo, Norway; Phoenix, Arizona; Nashville, Tennessee; Hamilton, Ontario, Canada; Uppsala, Sweden; Ghent and Liège, Belgium; Cleveland, Ohio; Novara, Italy; Rochester, Minnesota; Bucharest, Romania; and St. Louis, Missouri.Eur Heart J Cardiovasc Imaging. 2016; (12):1321-1360.
• 9- De Boeck BW, Cramer MJ, Oh JK, van der Aa RP, Jaarsma W: Spectral pulsed tissue Doppler imaging in diastole: a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle. Am Heart J 2003; 146: 411-9.
• 10- Hillis GS, Møller JE, Pellikka PA, Gersh BJ, Wright RS, Ommen SR, et al. Noninvasive estimation of LVfilling pressure by E/e’ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol. 2004;43(3):360-7.
• 11- Amundsen BH, Rognmo Ø, Hatlen-Rebhan G, Slørdahl SA. High-intensity aerobic exercise improves diastolic function in coronary artery disease, Scand Cardiovasc J, 2008;42:2, 110-117.
• 12- Miyashita T, Okano Y, Takaki H, Satoh T, Kobayashi Y, Goto Y. Relation between exercise capacity and LVsystolic versus diastolic function during exercise in patients after myocardial infarction. Coron Artery Dis. 2001;12:217-25.
• 13- Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of LVfilling pressures: a comparative simultaneous Doppler-catheterization study. Circ. 2000; 102: 1788–1794.
• 14- Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982; 284(6329): 1607–1608.
• 15- Dilek F. Koroner Arter Hastalarında Yaşam Kalitesinin Değerlendirilmesi. Yüksek Lisans Tezi, Trakya Üniversitesi Sağlık BilimleriEnstitüsü, Edirne, 2008, s. 84.
• 16- Chest Expansion. Assessment of chest expansion with deep inspiration helps identify the side of abnormality. Access Date: 22.10.2022 Available From: http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/chest.htm#:~:text=Normally%2C%20a%202-5%22,low%20in%20patients%20with%20COPD.
• 17- Karavidas AI, Raisakis, K.G., Parissis, J.T.,Tsekoura, D.K., Adamopoulos, S., Korres, D.A., et al. Functional electrical stimulation improves endothelial function and reduces peripheral immune responses in patients with chronic heart failure. Eur. J. Cardiovasc. Prev. Rehabil 2006.13,592–597.
• 18- Vancheri F, Gibson D. Relaıion of third and fourıh earı sounds to blood velocity during LVfilling. Br Heart J 1989; 61: 144-8.
• 19- Campos HO, Rodrigues QT, Drummond LR, Andrade Lima PM, Costa Monteiro M, Wanner SP, et al. Exercise-based cardiac rehabilitation after myocardial revascularization: a systematic review and meta-analysis. Rev. Cardiovasc. Med. 2022; 23(2), 074.
• 20- Vaquero A., Chicharro J., Gil L., Ruiz M., Sánchez V., Lucía A., et al. Effects of Muscle Electrical Stimulation on Peak VO 2 in Cardiac Transplant Patients. Int. J. Sports Med. 1998;19:317–322.
• 21- Ploesteanu, R. L., Nechita, A. C., Turcu, D., Manolescu, B. N., Stamate, S. C., Berteanu, M. Effects of neuromuscular electrical stimulation in patients with heart failure-review. Journal of Medicine and Life, 2018;11(2): 107.
• 22- Pekindil Y. Nöromusküler elektrik stimülasyonu ve izometrik egzersizin kuadriseps kasına etkilerinin TC-99m MIBI sintigrafisi ile değerlendirilmesi (Trakya Üniversitesi Tıp Fakültesi; Fiziksel Tıp ve Rehabilitasyon Uzmanlık Tezi); 2000, Edirne.
• 23- Appleton CP, Hatle LK. The natural history of LVfilling abnormalities: assessment by two-dimensional and Doppler echocardiography. Echocardıogr-J Card. 1992; 9: 437-57.
• 24- Apostolakis, E.E., Baikoussis, N.G., Parissis, H. Siminelakis SN, Papadopoulos GS. LVdiastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist. J Cardiothorac Surg 2009; 4, 67.
• 25- Edelmann F, Gelbrich G, Düngen HD, Fröhling S, Wachter R, Stahrenberg R, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex‐DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol. 2011;58:1780–1791.
• 26- Fontes-Carvalho, R., Sampaio, F., Teixeira, M., Rocha-Gonçalves, F., Gama, V., Azevedo, A. et al. LVdiastolic dysfunction and E/E’ ratio as the strongest echocardiographic predictors of reduced exercise capacity after acute myocardial infarction. Clin. Cardiol. 2015; 38(4):222–229.
• 27- Rengo JL. Savage PD. Hirashim F. Leavitt BJ. Ades PA. Toth MJ. Improvement in Physical Function After Coronary Artery Bypass Graft Surgery Using a Novel Rehabilitation Intervention, J Cardiopulm Rehabil Prev .2021;41(6):413-418.
• 28- Lakusic N, Mahovic D, Kruzliak P, Cerkez Habek J, Novak M, Cerovec D. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings. Biomed Res Int. 2015;2015:680515. 29- Burazor I, Lazovic M, Sprioski D, Andjic M, Moraca M. High blood pressure after coronary artery bypass surgery in patients referred to in- house cardiac rehabilitation. Single center experience. J Hypertens. 2015;33:130.
• 30- Hadem J. Rossnick R. Hesse B. Herr M. Hansen M. Bergmann A. et al. Endothelial dysfunction following coronary artery bypass grafting. Herz, 2020; 45(1):86-94.
• 31- Canet J, Gallart L. Predicting postoperative pulmonary complications in the general population. Curr Opin Anaesthesiol. 2013;26(2):107-15
• 32- Talvar S, Kumar MV, Sreenivas V, Gupta VP, Choudhary SK, Airan B. Exercise performance after univentricular palliation. Ann. Pediatr. Cardiol. 2018;11(1):40-47.
• 33- Hsieh MH, Fang YF, Chung FT, Lee CS, Chang YC, Liu YZ, et al. Distance-saturation product of the 6-minute walk test predicts mortality of patients with non-cystic fibrosis bronchiectasis. J. Thorac. Dis. 2017;9(9):3168-3176.
• 34- Demir R, Kucukoglu, M. S. Evaluation of exercise capacity in pulmonary arterial hypertension. Arch Turk Society Cardiology. 2010;38(8):580-588.
• 35- Cebeci F, Celik SS. Discharge training and counselling increase self-care ability and reduce postdischarge problems in CABG patients. J Clin Nurs 2008;17:412-20.
• 36- Kitzman DW, Groban L. Exercise intolerance. Heart Fail Clin. 2008;4:99–115.
• 37- Morais KA, Pereira MD, Cruz CJ, Drummond A. Respostas cardiovasculares agudas frente a diferentes testes funcionais em idosos. Rev Kairós. 2019;22(1):109-22.
• 38- Tribhuwan T , Nagarwala R , Dabadghav R , Shyam AK , Sancheti PK. Comparison of sit to stand test and two minute walk test for the evaluation of functional status in post cardiac valve replacement surgeries. Int. j. health sci. 2020;10(12).
• 39- Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G and Tenling A. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J 2003; 37(6):363-367.