| BackgroundCR has been proved to be beneficial to participants with coronary heart disease in the aspects of cardiovascular metabolic risk factors and exercise capacity.Whether cardiac damage caused by ACS could get benefits from CR has rarely been studied by far.The usual indicators of anthropometric measurements to evaluate obesity are BMI,WC and WHtR.The relationship between anthropometric measurements and effects of a long-term CR in young and middle-aged patients with ACS who obtained PCI has not been investigated,either.ObjectiveOur study aims at observing the effects of a long-term CR in young and middle-aged patients with ACS who obtained PCI and the influence of anthropometric measurements for evaluation of effects of a long-term CR.Then,prove that 1)Whether CR can improve the cardiac damage caused by ACS in young and middle-aged patients after PCI;2)Whether anthropometric measurements can assess effects of a long-term CR in young and middle-aged patients with ACS who obtained PCI.Subjects&methods1.Subjects128 participants were consecutively recruited with ACS in the General Hospital of Guangzhou Military Command of People's Liberation Army between September 2013 and February 2014 into our study.1.1 Inclusion criteria(a)established ACS,and more than one artery confirmed by CAG with the existence of coronary artery lesions>75%;(b)obtained the therapies of PCI;(c)being aged 18 to 60 years old,all genders;1.2 Exclusion criteria(a)patients with severe complications,such as malignant arrhythmia,acute congestive heart failure;(b)patients with serious chronic diseases,such as chronic obstructive pulmonary disease,renal insufficiency and hepatic insufficiency;(c)patients with nervous musculoskeletal diseases which can affect CR;(d)patients with cancer which can affect the prognosis.1.3 GroupsBased on the principle of voluntary,128 subjects were divided into two groups.60 subjects who underwent the CR were enrolled in rehabilitation group,and the other 68 subjects who underwent general treatment were assigned into control group.2.Methods2.1 Basic observation indexesThe basic information of participants,such as age,gender,hypertension,diabetes,smoking,was obtained at the moment of hospitalization.Vital signs,like HR,SBP,DBP,were measured at the same time on supine position.According to the actual situation of each patient,primary PCI or PCI after thrombolysis was performed to confirm the existence of coronary artery lesions>75%in at least one artery with a digital subtraction angiography machine.We finished the measurements of anthropometric data including height,weight,WC at the time of 3 to 5 days after PCI.And then,BMI and WHtR were calculated.Other indexes included the usage of ACEI/ARB,P receptor blockers and spironolactone after PCI.2.2 Clinical indexesCardiovascular metabolic risk factors included fasting blood glucose(FBG),triglycerides(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),blood uric acid(UA)and serum creatinine(SCR).Cardiac structure and function parameters included left ventricular end diastolic dimension(LVDd),left ventricular end systolic dimension(LVDs),interventricular septal thickness at diastole(IVSd),interventricular septal thickness at systole(IVSs),left ventricular posterior wall at diastole(LVPWd),left ventricular posterior wall at systole(LVPWs),ejection fraction(EF),and fractional shortening(FS).Exercise time,metabolic equivalents(METs),maximum net ST segment deviation,angina index,Duke Treadmill Score(DTS)were parameters for exercise capacity.2.3 The procedure of CRAll patients received secondary prevention of CHD,in addition,patients in rehabilitation group received CR at the same time.CR program mainly consisted of three parts,which were inpatient phase,early outpatient phase and long term outpatient phase.2.4 Follow upParticipants were called to come back for examinations including cardiovascular metabolic risk factors,cardiac structure and function and exercise capacity(exercise capacity was only for rehabilitation group)between October 2015 and April 2016.Because of some reasons we could not control,only 43 participants in rehabilitation group(38 males and 5 females)and 43 participants in control group(37 males and 6 females)came back for these examinations.3.Statistical analysisAnalyses were done with SPSS version 19.0.Continuous variables were presented as means ± SD and categorical variables were presented as percentages,respectively.One-way ANOVA,Chi-square,analysis of covariance,paired-samples t test,Pearson's correlation analysis,simple linear regression analysis and multiple linear regression analysis were performed.All significance tests were two tailed,and a P value less than 0.05 was regarded as statistically significant.Results1.Comparison of difference1.1 The comparison of baseline data showed that,in rehabilitation group,TC was higher,follow-up time was longer and onset age was lower than those in control group.1.2 The concentration of TG was lower in rehabilitation group compared with control group after more than one year's follow-up.1.3 In rehabilitation group,the concentration of TG,TC,and LDL-C was statistically lower at the time of more than 1 year after discharged compared with the time of hospitalization and the concentration of SCR was statistically higher.1.4 In control group,the concentration of TC,and LDL-C was statistically lower at the time of more than 1 year after discharged compared with the time of hospitalization and the concentration of SCR was statistically higher.1.5 LVDd and LVDs were smaller in rehabilitation group compared with control group after more than one year's follow-up.1.6 In rehabilitation group,IVSd,LVPWd and IVSs were statistically thinner at the time of more than 1 year after discharged compared with the time of hospitalization.1.7 In control group,IVSd,LVPWd,IVSd,IVSs,EF and FS were statistically smaller at the time of more than 1 year after discharged compared with the time of hospitalization.1.8 In rehabilitation group,ST segment deviation was statistically lower at the time of more than 1 year after discharged compared with the time of hospitalization and DTS was statistically higher.2.Correlation and regression analysis2.1 Before CR,FBG,LDL-C and HDL-C had correlations with the three anthropometric measurements,respectively.WC,however,was the only one to appear statistically significant correlation with UA;WHtR was the only one to appear statistically significant correlation with METs.After CR,TG,HDL-C,UA,IVSd,LVPWd and LVPWs had correlations with the three anthropometric measurements,respectively.WC and WHtR had correlations with FBG,respectively;WHtR had correlation with LDL-C.2.2 Simple linear regression analyses showed that BMI was the best index to predict IVSd,LVPWd and LVPWs after a long-term CR.2.3 Multiple linear regression analyses showed that BMI was the best index to predict LVPWd and LVPWs after a long-term CR.Conclusions1.A long-term CR may improve the level of TG,delay the dilation of left ventricular diameter in young and middle-aged patients with ACS after PCI.2.Anthropometric measurements can assess the effect of a long-term CR in young and middle-aged patients with ACS after PCI.BMI is a better index to assess left ventricular posterior wall after a long-term CR,while WC and WHtR are more relevant to cardiovascular metabolic risk factors. |
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