Is applying the same exercise-based inpatient program to normal and reduced left ventricular function patients the best strategy after coronary surgery? A focus on autonomic cardiac response

Autor(es)

Mendes, Renata Goncalves ^[1] ; Simoes, Rodrigo Polaquini ^[1] ; Melo Costa, Fernando de Souza ^[1] ; Falasco Pantoni, Camila Bianca ^[1] ; Di Thommazo-Luporini, Luciana ^[1] ; Luzzi, Sergio ^[2] ; Amaral-Neto, Othon ^[2] ; Arena, Ross ^[3] ; Catai, Aparecida Maria ^[1] ; Borghi-Silva, Audrey ^[1]

Afiliação do(s) autor(es)

^[1] Univ Fed Sao Carlos, Cardiopulmonary Physiotherapy Lab, Nucleus Res Phys Exercise, Sao Paulo - Brazil

^[2] Irmandade Santa Casa Misericordia Hosp, Sao Paulo - Brazil

^[3] Univ Illinois, Dept Phys Therapy, Coll Appl Hlth Sci, Chicago, IL - USA

• Tipo de documento: Artigo Científico
• Fonte: DISABILITY AND REHABILITATION; v. 36, n. 2, p. 155-162, 2014.
• Citações Web of Science: 3

Resumo

Purpose: To assess whether the same exercise-based inpatient program applied to patients with normal and reduced left ventricular function (LVF) evokes a similar cardiac autonomic response after coronary artery bypass graft (CABG). Method: Forty-four patients post-CABG, subgrouped according to normal LVF {[}LVFN: n = 23; left ventricular ejection fraction (LVEF) >= 55%] and reduced LVF (LVFR: n = 21; LVEF 35-54%), were included. All initiated the exercise protocol on post-operative day 1 (PO1), following a whole progressive program until discharge. Cardiac autonomic response was assessed by the indices of heart rate variability (HRV) at rest and during exercise (extremity range of motion and ambulation). Results: During ambulation, lower values of HRV indices were found in the LVFR group compared with the LVFN group {[}standard deviation of all RR (STDRR; 6.1 +/- 2.7 versus 8.9 +/- 4.7 ms), baseline width of the RR histogram (TINN; 30.6 +/- 14.8 versus 45.8 +/- 24.9 ms), SD2 (14.8 +/- 8.0 versus 21.3 +/- 9.0 ms), Shannon entropy (3.6 +/- 0.5 versus 3.9 +/- 0.4) and correlation dimension (0.08 +/- 0.2 versus 0.2 +/- 0.2)]. Also, when comparing the ambulation to rest change, lower values were observed in the LVFR group for linear (STDRR, TINN, RR TRI, rMSSD) and non-linear (SD2 and correlation dimension) HRV indices (p50.05). On PO1, we observed only intra-group differences between rest and exercise (extremity range of motion), for mean intervals between heart beats and heart rate. Conclusion: For patients with LVFN, the same inpatient exercise protocol triggered a more attenuated autonomic response compared with patients with LVFR. These findings have implications as to how exercise should be prescribed according to LVF in the early stages following recovery from CABG. (AU)

• Processo FAPESP: 09/54194-5 - Impacto do exercício físico associado à aplicação de CPAP no pós-operatório de cirurgia de revascularização do miocárdio
• Beneficiário: Camila Bianca Falasco Pantoni
• Modalidade de apoio: Bolsas no Brasil - Doutorado
• Processo FAPESP: 05/59427-7 - Efeito da modulação autonômica cardíaca em pacientes submetidos à cirurgia de revascularização do miocárdio e programa de fisioterapia: fase I da reabilitação cardiovascular
• Beneficiário: Audrey Borghi Silva
• Modalidade de apoio: Auxílio à Pesquisa - Regular