Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization.

BACKGROUND: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. AIM: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. METHODS: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient's symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3months after the end of the study. RESULTS: The mean age was 56.8±3.1years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3months after completion of CRP, there was a significant decrease in BMI (30.3±2.9 vs. 31.2±1.9, p<0.001), and mean blood pressure (93.4±11 vs. 105±10.6mmHg, p<0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1±0.62 vs. 1.4±0.6, p<0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7±7.8 vs. 54.5±6.3 %, p=0.06) and significant improvement of Canadian cardiovascular class (1.42±0.6 vs. 1.95±0.5, p<0.001) post CRP. Importantly, the difference between the SPECT-derived summed segmental scores at peak stress and at rest (SDS) was significantly lower after CRP (4.4±3 vs. 7.2±3, p<0.001). CONCLUSION: Participation in cardiac rehabilitation program improves ischemic burden in patients with IHD who are unfit or not suitable for conventional cardiac revascularization. In addition the decreased ischemic burden, functional capacity, hemodynamic and metabolic profiles also improve for this group of patients and thus, cardiac rehabilitation should be implemented for routine management of those patients.

Prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia: study by 99mTc-sestamibi radionuclide scintigraphy.

We explored the prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia (CAE), as demonstrated by (99m)Tc-sestamibi scintigraphy. Prospectively, we enrolled 35 patients with angiographically documented CAE and no significant coronary obstruction, who underwent elective coronary angiography. Patients underwent Stress-rest (99m)Tc-sestamibi scintigraphy within 4 days of coronary angiography. They were divided into 2 groups: group I: with normal perfusion scan; and group II: with reversible perfusion defects. The mean age was 49.6 ± 6.9 years; 34 (97.1 %) were males. Seventy-nine (75.2 %) arteries were affected by CAE. Among 79 arteries affected by CAE, affection was diffuse in 37 (46.8 %). Thirteen (37.1 %) patients had normal perfusion scan (group I), whereas 22 (62.9 %) had reversible perfusion defects (group II). Among 22 patients with reversible perfusion defects, 20 (90.9 %) had mild and 2 (9.1 %) had moderate ischemia. Among 49 myocardial segments with reversible perfusion defects, 22 (44.9 %) were basal, 18 (36.7 %) mid-, and 9 (18.4 %) apical segments. Diffuse CAE was significantly more prevalent in group II versus group I, in all 3 major coronary arteries (p < 0.05 for all). In patients with isolated CAE who underwent elective coronary angiography, reversible perfusion defects demonstrated by (99m)Tc-sestamibi scintigraphy were rather prevalent, mostly mild, more likely to affect the basal and mid-segments of the myocardium, and more frequently associated with diffuse ectasia.

Serum free L-carnitine in association with myoglobin as a diagnostic marker of acute myocardial infarction.

BACKGROUND: Early diagnosis of acute myocardial infarction (AMI) in patients with chest pain is necessary to initiate appropriate treatment. Elevation of ST-segment in ECG is the only marker that cardiologists depend on in diagnosis. The aim of this study was to monitor the level of serum free L-carnitine in combination with myoglobin (Myo) and creatine kinase (total activity and CK-MB level) for usefulness as a predictor of AMI in ICU patients. DESIGN AND METHODS: In the present study serum total CK activity and CK-MB, Myo, and free L-carnitine levels were determined in 90 patients admitted to the ICU at Ain Shams University Hospital and correlated the sensitivity and specificity of each parameter. RESULTS: Obtained data revealed that, 47/90 who were diagnosed as AMI showed a highly significant reduction in serum free L-carnitine level in all cases as compared to normal control (P<0.001), 24/90 diagnosed as unstable angina showed a non significant reduction of serum carnitine and 19/90 who were diagnosed as noncardiac showed non significant changes in the level of serum free carnitine as compared to normal control. In addition, serum free L-carnitine level was negatively correlated to CK-MB and Myo (r=-0.61 and -0.52) respectively. The sensitivity of carnitine assay was considerably higher (95.5%) compared to CK-MB (87%) and Myo (89.5%) even considering patients with a short delay until admission. CONCLUSION: Comparing the changes in serum total CK, levels of CK-MB, Myo and carnitine, the sensitivity and specificity were significantly higher for serum free L-carnitine. For this reason, serum free L-carnitine can be used as a good predictor for AMI diagnosis from other diseases.