ABSTRACT
Objective:To analyze the effects of exercise-based cardiac rehabilitation (ER) on patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to identify which type of ACS patients would benefit most in terms of cardiovascular functional capacity after ER. Methods:From December, 2017 to July, 2019, 31 ACS patients who discharged in a stable situation after PCI were studied. All patients were referred to a three-month ER program after discharge. They were divided into normal wall motion group (normal group, n = 14) and abnormal regional wall motion group (abnormal group, n = 17) according to baseline myocardial wall motion reported by echocardiography. The degree of wall motion abnormalities was quantified by the wall motion score index (WMSI). Echocardiography and cardiopulmonary exercise testing (CPET) were performed before and after ER. Results:Eight patients were dropped, and 23 patients completed the trial. WMSI decreased in the abnormal group (Z = -2.852, P = 0.004), and the left ventricular ejection fraction (LVEF) didn't change in both groups (P > 0.05) after ER. CPET showed that the heart rate at rest decreased in the normal group after ER (t = -2.268, P = 0.047); and the peak work rate, peak oxygen uptake, percentage of predicted value of peak oxygen uptake, peak minute ventilation and the third minute heart rate recovery increased in the abnormal group after ER (t > 2.739, P < 0.05). Conclusion:ER during recovery period could help more improve the cardiac function and exercise tolerance of ACS patients with abnormal WMSI after PCI. WMSI is an important indicator of cardiac function in ACS patients with preserved ejection fraction.
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Objective To evaluate the effect of percutaneous coronary intervention (PCI) on chronic total occlusion (OCT) by doubutamine stress echocardiography. Methods Forth-six CTO patients were categorized into the reopening group and failed-reopening group based on the results of PCI. All patients had undergoing low dose doubutamine stress echocardiography before PCI and at 6-month follow-up, measuring rest and stress wall motion score index (WMSI) with semi-quantitative method. Cardiac volumes and ejection fraction were measured with 3D full volume echocardiographic. Results The two groups showed no differences in general clinical data and all baseline echocardiography data before PCI. During follow-up, the reopening group was observed to have improvement in ejection fraction[(60.00±3.22)% vs.(62.65±3.58)%,P=0.017)],and WMSI in stress status[(1.42±0.37)vs.(1.32±0.36),P<0.001], compared with pre-PCI results. The reopening group showed improvement in ejection fraction[(62.65±3.58)% vs.(57.7±5.61)%,P=0.001)]and WMSI in stress status[(1.32±0.36)vs.(1.62±0.47),P<0.001)],when compared with the failed-reopening group. Conclusions Low dose doubutamine stress echocardiography can be nsed for evaluation of the eff ect of revascularization of CTO. The cardiac volumes and contractile function representing by wall motion in stress status were improved after recanalization of CTO.
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Objective To study the value of echocardiogram in preoperative examination for the diagnosis of silent myocardial is-chemia in patients before surgery .Methods 172 patients with surgical preoperative suspected diagnosis of coronary heart disease , were divided into heart valve surgery group (72 cases) and non heart valve surgery group (100 cases) .All of the patients had echo-cardiography and coronary angiography before 2 weeks of operation .We drew a series of analysis to assess the sensitivity、specialty and accuracy of diagnosis of silent myocardial ischemia with regional wall motion abnormality (RWMA) and wall motion score in-dex (WMSI) .Results Coronary angiography as the gold standard of coronary heart disease diagnosis .The sensitivity of RWMA for the diagnosis of silent myocardial ischemia in patients undergoing heart valve surgery group and non heart valve surgery group was 85 .7% and 100 .0% ,while the specificity of RWMA was 100 .0% and 80 .0% ,respectively ,the differences between the two groups had no statistical significance (P>0 .05) .We also drew the ROC curve of WMSI for the diagnosis of silent myocardial ische-mia ,maximum area under the ROC curve of WMSI were 2 .20 and 2 .05 .In patients undergoing cardiac surgery and non-cardiac sur-gery ,the curves indicated that the sensitivity were 79 .7% and 75 .9% ,the specificity were 83 .0% and 67 .7% ,respectively .Area under the ROC curve was 0 .832 and 0 .702 ,but the difference was not statistically significant (P>0 .05) .Conclusion Using RW-MA and WMSI as reference indicators ,surgical preoperative echocardiography in the diagnosis of patients with silent myocardial is-chemia has good sensitivity ,specific ,and accurate ,there is no statistically significant difference between heart valve surgery and non heart valve surgery .
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Objective To study the probability of evaluating myocardial tissue perfusion by corrected TIMI frame count (CTFC) after successful percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods Sixty-three patients with their first acute myocardial infarction (AMI) who accepted primary coronary intervention were recruited. All these patients got TIMI 3 grade flow. CTFC was measured after successful PCI in these patients. Wall Motion Score Index (WMSI) assessed by two-dimensional echocardiography before and one month after PCI and the correlation studied between CTFC and WMSI. Results According to CTFC the patients were divided into two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group. CTFC had a significant correlation with the change in WMSI. Elapsed time from the onset of symptoms to reperfusion in the TIMI slow group was significantly longer than that of the TIMI fast group. Conclusion CTFC is a quantitative, and reproducible index of coronary blood flow. Lower CTFC is associated with greater functional recovery and could supply evidence for additional adjunctive treatment.