RESUMO
Background: It has been suggested that the autonomic system function and the metabolic syndrome can significantly affect patients' survival. The aim of the current study was to investigate the impact of the cardiac rehabilitation program on the autonomic system balance in patients with coronary artery disease
Methods: Patients with a previous diagnosis of coronary artery disease who were referred to the Cardiovascular Rehabilitation Center of Afshar Hospital [Yazd, Iran] between March and November 2011 were enrolled. All the patients participated in rehabilitation sessions 3 times a week for 12 weeks. Heart rate recovery [HRR] was measured as an indicator of the autonomic system balance. In order to calculate HRR, the maximum heart rate during the exercise test was recorded. At the end of the exercise test, the patients were asked to sit down without having a cooldown period and their heart rate was recorded again after 1 minute. The difference between these 2 measurements was considered as HRR
Results: A total of 108 patients, including 86 [79.6%] men and 22 [20.4%] women, completed the rehabilitation course. The mean age of the study participants was 58.25 +/- 9.83 years. A statistically significant improvement was observed in HRR [p value = 0.040]. Significant declines were also observed in the patients' waist circumference [p value < 0.001] and systolic and diastolic blood pressures [p value = 0.018 and 0.003, respectively]. A decreasing trend was observed in the patients' body mass index, but it failed to reach statistical significance [p value = 0.063]. No statistically meaningful changes were noted in fasting blood glucose [p value = 0.171], high-density lipoprotein [p value = 0.070], or triglyceride concentrations [p value = 0.149]
Conclusion: The cardiac rehabilitation program may help to improve HRR and several components of the metabolic syndrome in patients with coronary heart disease
RESUMO
The transcatheter closure of the atrial septal defect [ASD] has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder [ASO] in adult Iranian patients. Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58 consecutive, adult patients. The mean age of the patients was 37.1 +/- 12.7 years [range = 19 - 75 years]. All the procedures were performed under local anesthesia with transthoracic or transesophageal echocardiography and fluoroscopic guidance. The stretched diameter of the ASD was determined with a balloon sizing catheter, and device selection was based on and matched to the stretched diameter of the septal defect. Transthoracic echocardiography was performed immediately after the release of the device and before discharge. Further follow-up at one month, six months, and yearly thereafter included physical examination, electrocardiography, and transthoracic echocardiography. The mean ASD diameter, as measured by esophageal echocardiography, was 24.8 +/- 5.4 mm [range = 13 - 34 mm]. The mean stretched diameter, as measured by the balloon catheter, was 27.1 +/- 6.4 mm [range = 12.5 - 39 mm]. Deployment of the ASO was successful in 52 [89.6%] patients and failed in 6 [10.4%]. Four patients experienced severe complications, 1 had tamponade requiring drainage, 2 had device embolization to the left atrium and right ventricular outflow tract, and 1 had late wire fracture [surgical removal and repair of the ASD]. The position of two large devices [34 mm and 36 mm] was considered unsuitable and unstable after implantation and resulted in the removal of these devices. Minor complications included transient complete atrioventricular block in 1 patient, paroxysmal supra tachycardia in 3 patients, atrial flutter in 1 patient, and angina pectoris with transient ST elevation in 2 patients. The mean follow-up period was 32.5 +/- 18.5 months. Echocardiography at 24 hours, 1 month, 6 months, and 12 months after the procedure showed residual shunts in 11 [21%], 3 [5.8%], 2 [3.8%], and 2 [3.8%] patients, respectively. At follow-up [12.8 months to 48.5 months, mean +/- SD = 32.5 +/- 18.5 months], complete closure was documented in 50 [96.2%] of the 52 cases. At the end of the follow-up, 2 [3.8%] patients had residual shunts: The shunt was moderate in 1 [1.9%] patient and small in the other [1.9%]. The overall success rate of the transcatheter closure of the ASD was 86% [50 of 58 cases]. The transcatheter closure of the secundum ASD in our adult patient population using the ASO was associated with high degrees of success, minimal procedural complication rates, and excellent short and midterm results. The use of this device, however, requires thorough attention in that the procedure may be ineffective or the device may embolize. Further experience and long-term follow-up are required before a widespread clinical use can be recommended