STRUCTURAL AND FUNCTIONAL CHANGES OF THE MYOCARDIUM AFTER CORONARY ARTERY BYPASS GRAFTING IN OVERWEIGHT PATIENTS AT DIFFERENT STAGES OF REHABILITATION
Background. The global role of fatal complications of cardiovascular diseases is of great importance, since they are the leading cause in the structure of total mortality of the entire population. Extensive use of interventional and reconstructive methods has made it possible to make progress in the treatment of cardiovascular diseases, ensuring the restoration of blood flow in the arteries of the myocardium. However, at the stage of rehabilitation after the restoration of coronary blood flow, serious problems arise associated with post-revascularization complications and remodeling of the heart.
The aim of the study was to study the structural and functional changes of the myocardium in overweight patients after coronary artery bypass grafting in dynamics at the stages of rehabilitation.
Materials and methods: The cohort study included 97 patients hospitalized at the Regional Cardiac Surgery Center, and Tulpar Cardio Rehabilitation Center in Karaganda, who were treated from February to September 2021. The patients were divided into 2 groups: group 1 (main group) - overweight patients after coronary artery bypass grafting (n=54) and group 2 (comparison group) - patients with normal body weight after coronary artery bypass grafting (n=43). The patients were examined on the first day after blood flow was restored at the regional cardiac surgery center, then at the 1st, 2nd and 3rd stages of cardiac rehabilitation at the Tulpar center. The patients underwent a clinical examination: a survey of complaints, physical examination with anthropometry, determination of body mass index. Among the instrumental research methods, an electrocardiogram (ECG) in 12 standard leads and transthoracic echocardiography (echocardiography) were used. Statistical analysis of the data was carried out using the STATISTICA 12 software. The nonparametric Kraskel-Wallis criterion was used to compare continuous values, and the Spearman correlation coefficient was used for correlation analysis. The differences were considered statistically significant at p<0.05.
Results: in overweight patients after coronary artery bypass grafting, the mass index of the left ventricular myocardium, the relative wall thickness gradually decreases at the first and second stages of rehabilitation, increases again at the third stage of rehabilitation.
Conclusions: despite the good dynamics at the first and second stages of rehabilitation, we did not observe a positive dynamics of structural changes in the myocardium at the third stage of rehabilitation in overweight patients who underwent coronary artery bypass grafting.
Aizhan N. Seytekova1*, https://orcid.org/0000-0003-4501-2454
Vilen B. Molotov-Luchanskiy1, https://orcid.org/0000-0001-8473-4375
Zarina K. Kavkenova1, https:// orcid.org/0009-0004-8836-9116
1 Karaganda Medical University, Karaganda, Republic of Kazakhstan.
1. Акчурин P.C., Ширяев А.А. Актуальные проблемы коронарной хирургии. М.: ГЭОТАР-МЕД, 2004. 88 с.
2. Аншелес А.А., Бадтиева В.А., Балахонова Т.В. и др. Кардиоваскулярная профилактика 2022. Российские национальные рекомендации // Российский кардиологический журнал. 2023. 28(5):5452. doi:10.15829/1560-4071-2023-5452
3. Асадуллин И.Ш., Каменских М.С., Филиппов A.А., Ефремов С.М. и др. Факторы, определяющие качество жизни у пациентов с ишемической болезнью сердца, которым планируется операция аортокоронарного шунтирования // Сибирский журнал клинической и экспериментальной медицины. 2023. 8(4):213-221. https://doi.org/10.29001/2073-8552-2023-38-4-213-221.
4. Бойцов С.А., Деев А.Д., Шальнова С.А. Смертность и факторы риска неинфекционных заболеваний в России: особенности, динамика, прогноз // Терапевтический архив. 2017. 89(1): 5 - 13.
5. Бокерия Л.А., Беришвили И.И., Сигаев И.Ю. Минимально инвазивная реваскуляризация миокарда. М.: Изд-во НЦССХ им. А.Н. Бакулева РАМН, 2001. 276 с.
6. Бокерия Л.А. Современные тенденции развития хирургии сердца. Анналы хирургии. 2011. 1:10–18.
7. Кремлёв Д.И. Влияние положительной жировой дистрофии на развитие инфаркта миокарда. Парадокс ожирения // Вестник Российской военно-медицинской академии. 2018. 3:204-211.
8. Миклишанская С.В., Мазур Н.А., Соломасова Л.В., Чигинева В.В. «Парадокс ожирения» и степень его доказанности // Терапевтический архив. 2020. 4:84-90
9. Михайлов В.В. Основы патологической физиологии: Руководство для врачей. М.: Медицина, 2001.704 с. - ISBN 5-225-04458-1.
10. Протопопов А.В. Увеличение количества первичных чрескожных коронарных вмешательств. Как этого добиться? // Комплексные проблемы сердечно-сосудистых заболеваний. 2013. 1:40–43.
11. Сумин А.Н., Безденежных А.В. и др. Индекс массы тела у больных ишемической болезнью сердца и непосредственные результаты коронарного шунтирования // Российский кардиологический журнал. 2015. (11):63-69. https://doi.org/10.15829/1560-4071-2015-11-63-69
12. Abel Romero-Corral, Victor M. Montori, Virend K. Somers, Josef Korinek, Randal J. Thomas, Thomas G. Allison, Farouk Mookadam, Francisco Lopez-Jimenez Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies // Lancet. 2006. 368(9536):666-78. doi:10.1016/S0140-6736(06)69251-9.
13. Abhishek Sharma, Ajay Vallakati, Andrew J Einstein, Carl J Lavie, Armin Arbab-Zadeh, Francisco Lopez-Jimenez, Debabrata Mukherjee, Edgar Lichstein Relationship of body mass index with total mortality, cardiovascular mortality, and myocardial infarction after coronary revascularization: evidence from a meta-analysis // Mayo Clin Proc. 2014. 89(8):1080-100. doi: 10.1016/j.mayocp.2014.04.020. Epub 2014 Jul 16.
14. Aronov D., Bubnova M., Iosseliani D., Orekhov A. Clinical Efficacy of а Medical Centre- and Home-based Cardiac Rehabilitation Program for Patients with Coronary Heart Disease After Coronary Bypass Graft Surgery // Archives of medical research. 2019. 50(3):122-132.
15. Barnaby C.R., Raimondo A., Martin H.Ch., Gianni D.A. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery // Journal of the American College of Cardiology. 2003. 42(4):668-676. https://doi.org/10.1016/S0735-1097(03)00777-0
16. Becker M.A., Jr. Schumacher H.R., Wortman R.L. Febuxostat compared with allopurinol in patients with hyperuricemia and gout // N. Engl. J. Med.2005. 353:2450-2461.
17. Brandt M., Harder K., Knut P. et al. Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery // Eur J Cardiothoracic Surg. 2001. 19:662–666.
18. Chrysi Koliaki, Stavros Liatis, Alexander Kokkinos. Obesity and cardiovascular disease: revisiting an old relationship // Metabolism. 2019. 92:98-107. doi: 10.1016/j.metabol.2018.10.011.
19. Csige I., Ujvárosy D., Szabó Z. et al. The Impact of Obesity on the Cardiovascular System // Journal of Diabetes Research 2018. Article ID 3407306. https://doi.org/10.1155/2018/3407306 (accessed 12.07.2018)
20. Eltzschig H.K., Macmanus C.F., Colgan S.P. Neutrophils as sources of extracellular nucleotides: functional consequences at the vascular interface // Trends Cardiovasc. Med. 2008. 18:103–107.
21. Franz-Josef Neumann, Miguel Sousa-Uva, Anders Ahlsson. ESC/EACTS Guidelines on Myocardial Revascularization, 2018 // European Heart Journal. 2019. Vol 40:87–165, https://doi.org/10.1093/eurheartj/ehy394
22. Gahl B., Gober V., Odutayo A. et al. Prognostic Value of Early Postoperative Troponin T in Patients Undergoing Coronary Artery Bypass Grafting // J Am Heart Assoc. 2018. 7(5): e007743. doi: 10.1161/JAHA.117.007743.
23. Garcia-Dorado D. et al. Calcium-mediated cell death during myocardial reperfusion // Cardiovasc. Res. 2012. 94(2):168–180.
24. Hajar R. Risk factors for coronary artery disease: historical perspectives // Heart Views. 2017. 18 (3): 109–114. Available at: doi:10.4103/HEARTVIEWS_106_17. (accessed 22.02.2019).
25. Hilmi Tokmakoglu. Operative and early results of coronary artery bypass grafting in female patients in different body mass indexes // Journal of Cardiothoracic Surgery, 2010. 5(119):1-6.
26. Hisato T., Takuya U. Overweight, but not obesity, paradox on mortality following coronary artery bypass grafting // J Cardiol. 2016. 68(3):215-21. doi: 10.1016/j.jjcc.2015.09.015.
27. Iacobellis G., Ribaudo M.C., Zappaterreno A. et al. Relation between epicardial adipose tissue and left ventricular mass // Am J Cardiol. 2004. 94 (8): 1084–7.
28. Komarova I.S., Zhelnov V.V., Andreeva N.V., Dvoretsky L.I. Post-reperfusion syndrome in patients with coronary heart disease after coronary stenting // Clin. Med., 2018. 96(1):73–77.
29. Rachel H. ‘Obesity paradox’ not found measuring new cases if cardiovascular disease // Journal LOS ONE. 2017. 12:14-16.
30. Sivaraman V., Yellon D.M. Pharmacologic Therapy That Simulates Conditioning for Cardiac Ischemic / Reperfusion Injury // J. Cardiovasc. Pharmacol. Ther. 2014. 19(1):83–96.
31. Tiffany M. Powell-Wiley, Paul Poirier, Lora E. Burke. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association // Circulation. 2021. 143(21): e984-e1010. doi:10.1161/CIR.0000000000000973.
32. UN News. https://news.un.org›story›2017/09 (accessed: 29.09.2017).
References:
1. Аkchurin R.S., Shiryaev А.А. Aktual'nye problemy koronarnoi khirurgii [Actual problems of coronary surgery]. M.: GEOTAR-MED [M.: GEOTAR-MED]. 2004.88.p. [in Russian]
2. Ansheles A.A., Badtieva V.A., Balakhonova T.V. i dr. Kardiovaskulyarnaya profilactica 2022. Rossiskie natsional'nye recomendatsii [Cardiovascular prevention 2022. Russian national recommendations]. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology. 2023.28(5):5452. doi:10.15829/1560-4071-2023-5452. [in Russian]
3. Asadullin I.Sh., Kamenskikh M. S., Philippov A.A., Efremov S.M., et al. Faktory, opredelyayushie kachestvo zhizni u patsientov s ishemicheskoi bolezn'yu serdtsa, kotorym planiruetsya operatsiya aortokoronarnogo shuntirovaniya [Factors determining the quality of life in patients with coronary artery disease who are scheduled for coronary artery bypass surgery] Sibirskii zhurnal klinicheskoi i eksperimental'noi medisiny [Siberian Journal of Clinical and Experimental Medicine]. 2023. 38(4):213-221. https://doi.org/10.29001/2073-8552-2023-38-4-213-221. [in Russian]
4. Boytsov S.A., Deev A.D., Shal'nova S.A. Smertnost' i faktory riska neinfektsionnykh zabolevanii v Rossii: osobennosti, dinamika, prognoz. [Mortality and risk factors of non-communicable diseases in Russia: features, dynamics, prognosis]. Terapevticheskii arkhiv [Therapeutic archive]. 2017. 89(1):5-13. [in Russian]
5. Bokeriya L.A., Berishvili I.I., Sigaev I.Yu. Minimal'no invazivnaya revaskulyarizatsiya miokarda [Minimally invasive myocardial revascularization]. M.: Izd- vo NCSSKh im. A.N. Bakuleva RAMN [M.:Publishing house NCSSH named after A.N.Bakulev RAMS]. 2001.276 p. [in Russian]
6. Bokeriya L.A. Sovremennye tendensii razvitiya khirurgii serdtsa [Modern trends in the development of heart surgery]. Annaly khirurgii [Annals of Surgery]. 2011. 1:10–18. [in Russian]
7. Kremlev D.I. Vliyanie polozhitel'noi zhirovoi distrofii na razvitie infarkta miokarda. Paradoks ozhireniya [The effect of positive fatty degeneration on the development of myocardial infarction. The paradox of obesity]. Vestnik Rossiiskoi voenno-meditsinskoi akademii [Bulletin of the Russian Military Medical Academy]. 2018. 3:204-211. [in Russian]
8. Miklishanskaya S.V., Mazur N.A., Solomasova L.V., Chigineva V.V. «Paradoks ozhireniya» i stepen' ego dokazannosti ["The obesity paradox" and the degree of its proof] Terapevticheskii arkhiv [Therapeutic Archive]. 2020. 4:84-90. [in Russian]
9. Osnovy patologicheskoi fiziologii: Rukovodstvo dlya vrachei [Fundamentals of pathological physiology: A guide for doctors]. pod red.V.V.Mikhailov –M.:Meditsina [ed. V.V. Mikhailov –M.:Medicine]. 2001. 704 p. ISBN 5-225-04458-1. [in Russian]
10. Protopopov A.V. Uvelichenie kolichestva pervichnykh chrezkozhnykh vmeshatel'stv. Kak etogo dobit'sya? [An increase in the number of primary percutaneous coronary interventions. How can this be achieved?]. Kompleksnye problemy serdechno-sosudistykh zabolevanii [Complex problems of cardiovascular diseases]. 2013. 1:40–43. [in Russian]
11. Sumin A.N, Bezdenezhnykh A.V. et al. Indeks massy tela u bol'nykh ishemicheskoi bolezn'yu serdtsa I neposredstvennye rezul'taty koronarnogo shuntirovaniya [Body mass index in patients with coronary artery disease and immediate results of coronary bypass surgery]. Rossiiskii kardiologogicheskii zhurnal [Russian Journal of Cardiology]. 2015. (11):63-69. https://doi.org/10.15829/1560-4071-2015-11-63-69. [in Russian]
Number of Views: 213
Category of articles:
Original articles
Bibliography link
Seytekova A.N., Molotov-Luchanskiy V.B., Kavkenova Z.K. Structural and functional changes of the myocardium after coronary artery bypass grafting in overweight patients at different stages of rehabilitation // Nauka i Zdravookhranenie [Science & Healthcare]. 2024. Vol.26 (2), pp. 45-52. doi 10.34689/SH.2024.26.2.006Related publications:
VALIDATION OF THE KAZAKH VERSION OF THE DEPRESSION ANXIETY STRESS SCALE (DASS-21) IN MEDICAL FACULTY STAFF SAMPLE: THE PILOT STUDY
PREDICTIVE VALUE OF PSYCHOMETRIC TESTING IN CONTEXT OF CREATING ADAPTIVE ENVIRONMENT FOR HIGHER MEDICAL EDUCATION
ASSESSMENT OF STUDENTS' AWARENESS ABOUT THE HARMS OF MICROPLASTICS ON THE HUMAN BODY
THE IMPACT OF COMPLAINTS ON QUALITY OF LIFE, PSYCHOLOGICAL WELL-BEING AND HEALTH OF MEDICAL WORKERS
DEVELOPMENT AND VALIDATION OF A QUESTIONNAIRE FOR PATIENTS "STUDYING THE OPINION OF PATIENTS' SATISFACTION WITH NURSE INDEPENDENT APPOINTMENT AT THE LEVEL OF PRIMARY HEALTH CARE"