impact of cardiac rehabilitation on the quality of life and functional capacity in patients with coronary artery disease

Despite major technologic advances in the field of cardiovascular medicine, coronary artery disease CAD remains the major cause of death worldwide. Comprehensive cardiac rehabilitation programs have been shown to reduce mortality from coronary heart disease, re-infraction rates and hospital admissions

Objective: It was noticed that patients CAD are not receiving proper physical rehabilitation program as a way to gain full functional ability and psychosocial cooping and the only care they have is medical measures

Aim of the work: To evaluate the impact of a specially designed cardiac rehabilitation program on physical, psychosocial, status and awareness of patients with coronary artery disease

Subjects and methods: Our study consisted of 48 CAD patients admitted to the coronary care unit [CCU] with acute attack of ischaemic heart disease [IHD], 24 as patient group and 24 as a control group. Both group performed the same clinical examination, investigations and received same medical treatment except for the rehabilitation program which was introduced to the patient group only

Results: A significant improvement in quality of life, blood pressure, BMI, high density lipoproteins and functional capacity was found among patients group when compared with control group

Conclusion: Cardiac rehabilitation program improve the quality of life and the functional capacity of patients with CAD. In addition it modifies some of CAD risk factors as obesity, hypertension and stress

Predictors of multivessel coronary artery disease using dobutamine stress echocardiography

The detection of multivessel coronary artery disease [MVD] is of paramount importance to cardiologists as such group of patients carry a poor prognosis and benefit to a great extent from more aggressive treatment strategies. The value of Dobutamine stress echocardiography [DSE] has been evaluated in the diagnosis of coronary arty disease [CAD], but few studies have been performed to assess the predictors of MVD during this test. this study was designed to determine the clinical, electrocardiographic predictors of MVD during DSE. this study included 51 patients with suspected CAD who underwent clinically indicated coronary arteriography, with DSE performed within 8 weeks of the angiographic study. Different clinical, electrocardiographic and echocardiographic predictors of MVD were assessed using multivariate analysis. Diabetes mellitus [DM], hypertension [HTN], and dyslipideamia were the most prevalent risk factors among patients with MVD. Coronary angiography revealed that 17.5% of patients had normal or non-significant lesion, 39.4%had single vessel disease [SVD], 19.6% had two-vessel disease [2VD] while 23.5% had MVD. DSE had a sensitivity of 96% and 68% for MVD and SVD respectively while the specificity was 85% and 53% respectively. Multivariate analysis showed 5 variables to be independent predictors of multivessel CAD including: History of DM [p=0.031], history of previous myocardial infarction [MI] [p=0.013], electrocardiographic ST-T changes in more than one vascular territory [p=0.0001], segment wall motion [SWM] abnormalities in more than one vascular territory [p=0.008], and SWM score index more than 1.7 [p=0.010]. DSE is a reasonably sensitive and specific non-invasive tool for the diagnosis of CAD, particularly MVD. History of DM, history of previous MI, electrocardiographic ST-T changes in more than one vascular territory, SWN abnormalities in more than one vascular territory, and SWM score index more than 1.7 are all independent predictors of MVD

Pro-collagen peptides in essential hypertension and its relation to cardiac structure and functions before and after antihypertensive therapy

A significant increase in fibrillar collagen content, type I and type III, has been observed in the cardiac ventricles of both animals and humans with arterial hypertension. The serum concentrations of procollagen type I carboxy terminal peptide [PIP] and procollagen type III amino terminal peptide [PIIIP] have been proposed as a useful markers of collagen types I and III synthesis. We evaluated fibrogenic activity in patients with essential hypertension by measuring serum concentrations of PIP and PIIIP as markers of tissue synthesis of collagen type I and type III, and its relation to parameters of left ventricular [LV] structure and functions in those patients. The effect of treatment with ACE inhibitor [captopril] for 6 months on serum concentrations of both PIP and PIIIP was also studied. The study included 79 patients with newly diagnosed mild to moderate hypertension and 50 normotensive subjects. Ages ranged between 35 to 60 years. Careful blood pressure measurement was obtained in all subjects. M-mode, two dimensional, and pulsed Doppler were performed to get baseline LV anatomy and function. Serum PIP and PIIIP were measured by radioimmunoassay. Both echocardiography and biochemical studies were repeated for all hypertensives after 6 months treatment with captopril. Serum PIP and PIIIP were significantly higher in hypertensive patients compared with normotensive subjects. PIP was 258 +/- 57mg/L in hypertensives vs. 167 +/- 70mg/L in normotensives. PIIIP was 3.73 +/- 2.2mg/L in hypertensives vs. 1.9 +/- 1.4mg/L in normotensives. In addition, PIP and PIIIP were significantly higher in hypertensives with LV hypertrophy [LVH] than those with normal LV mass. Moreover, serum concentration of PIP was directly correlated with LV mass index. On the other hand, PIIIP was inversely correlated with VE/VA ratio. After treatment, significant echocardiographic and biochemical improvements were observed. LVH regressed in 13 out of 68 patients [19%], LV mass index was normalized in 17 out of 58 patients [29%], and diastolic dysfunction was normalized in 10 out of 44 patients [23%]. Serum PIP and PIIIP were significantly reduced in hypertensives. Serum concentrations of both PIP and PIIIP are significantly increased in hypertensives and this was more pronounced among patients with LVH. This was correlated with structural and functional LV changes in the form of LVH and diastolic dysfunction. All changes demonstrated significant improvement after treatment with captopril