A Single-center Clinical Study Of The Rehabilitation Of Physiological Ischemic Training In Patients With Coronary Heart Disease Complicated With Heart Failure

PART 1The single center analysis of present situation of cardiopulmonary exercise capacity in patients with coronary heart disease complicated with heart failure and body composition risk factor.ObjectiveTo observe the cardiopulmonary exercise capacity and the risk factor of body composition of patients with coronary heart disease complicated with heart failure.To choose the appropriate project of exercise testing and training for such patients as well as for screening of body composition analysis,provide the basis for the risk stratification and health guidance.MethodsRetrospective analysis was performed on 66 patients with cardiopulmonary rehabilitation from June 2014 to March 2017.Record the general conditions of the patient,including age,gender,body mass index;Medical history: hypertension,diabetes,smoking,family history of coronary heart disease,exercise habit,hyperlipidemia;Classification of heart failure(NYHA);Drug application: angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor blockers(ARB),calcium channel blockers(CCB),beta blockers(beta BLOCK),statins(STAIN),nitrate,antiplatelet,diabetes drugs.All subjects were measured for height,weight,BMI and resting blood pressure before the exercise test.For human body composition analysis,draw the following indicators: Percentageof body fat,body mass index(BMI),waist-to-hip ratio,body fat mass,body fat,body muscle,body water content,Protein content,Visceral fat.Complete symptoms restrictive cardiopulmonary exercise test,it is concluded that cardiopulmonary exercise test indicators are as follows: subjective fatigue rating(RPE)grade,quiet heart rate(HR)for Rest,PEAK kilograms oxygen uptake(VO2 / Kg @ PEAK),anaerobic threshold kilograms oxygen uptake(VO2 / Kg @ AT),PEAK systolic blood pressure(SBPpeak),PEAK diastolic blood pressure(DBPpeak),oxygen pulse /HR(VO2 / HR).According to the maximum metabolic rate of the cardiopulmonary test results,it was divided into four groups: the horizontal P group,the low motion level L group,the moderate exercise level M group.Group M(5? METs);Group L(3 ? METs< 5);P group(METs<3).ResultAmong all the subjects,the exercise capicity was 22.7% lower than that of 3METS,46.9% of the exercise capicity in 3-5mets,30.3% in exercise capicity in above 5mets.Grouped according to the scope of the biggest metabolic equivalent,found in the M,L,P group,VO2 @ LT,VO2 @ PEAK,VO2 / Kg @ LT,VO2 / Kg @ PEAK,VO2 / KgPred decreased with the reduce of metabolic equivalent,difference between groups was statistically significant(P < 0.05);In the M,L and P groups,VE @peak,HR @lt,HR@peak,HR@recov,VO2/HR@LT,VO2/HR @peak decreased with the decrease of metabolic equivalent,and the differences between groups were statistically significant(P <0.05).In M,L and P groups,br@ PEAK,VE/VCO2@ PEAK increased with the decrease of metabolic equivalent,and the difference between groups was statistically significant(P <0.05).In the M,L and P groups,there was no statistically significant difference in HR@rest between groups.The obesity rate detected by the Percent body fat was defined as obese: 37.8%(male),19.1%(female).Grouped according to the scope of the biggest metabolic equivalent,found in group M,L,P,PBF(21.09± 6.87)of P group was the lowest,and the difference between groups was statistically significant(P <0.05).In the P group,the metabolic equivalent was the lowest,and the PBF was the lowest.The overweight rate detected by BMI(greater than or equal to 25,WHO standard): 49%;Obesity rate(greater than or equal to 30): 11%.Waist-to-hip ratio(WHR)detection rate :(ACSM standard,male greater than 0.95,female greater than 0.86)30.5%;According to the Chinese standard(male is greater than or equal to 0.85,female is greater than 0.80),the detection rate is 69.4%.Conclusion1.The metabolic equivalent of the elderly patients with coronary heart disease and heart failure was the largest part in whole study in less than 5METS,indicating that their exercise training was most in need of monitoring,and the exercise prescription design was less intense.2.With the reduce of METs,ventilation,heart rate at anaerobic threshold,peak heart rate,heart rate recovery,oxygen/pulse,the peak oxygen pulse is also reduced,it means that heart rate,oxygen /pulse,ventilation,have a connection with exercise capacity.Exercise capacity is reduced,the whole response of the cardiovascular system and respiratory system is reduced,to a certain extent,the cause of patients with coronary heart disease with heart failure movement failed may be the cause of cardiovascular system response to peak,instead of the respiratory system-lung function has reached the peak.Carbon dioxide equivalent ventilation increases with the reduction of METs,showed that patients with heart failure severity and associated metabolic equivalent,VE/VCO2 is an independent predictor of heart failure,the higher its value,the higher the index of heart failure.3.In P group,the metabolic equivalent is the least,and PBF is the smallest,which may be associated with severe physical deterioration,and the patients with heart failure with long course of disease have too much body fat consumption.4.Show the PBF of body composition can be used to calculate the detection rate of obesity,body fat rate is higher,may be related to many muscles in elderly patients with coronary heart disease with heart failure and lost a lot of body fat,PBF can detect visceral fat content,so than using BMI(i.e.,weight/height squared)conforms to the characteristics of this group.PART 2 Physiological ischemia training to the patients with coronary heart disease complicated with heart failure-Single center clinical study.ObjectiveTo observe the safety of training,effective and possiblity mechanism of physiological ischemia training for patients with coronary heart disease complicated with heart failure.MethodsPatients collected from January 2016 to January 2017 of coronary heart disease with heart failure,according to whether they want to participate in this study included in 49 cases,in the follow-up observation,in succession fall off 19 cases,30 patients with residual(male 17,female 13)to complete research,average age(76.15 ±10.61),according to random number table method is divided into control group and physiological ischemia training group(PIT-isometric fisting group).Among them,15 of the PIT training group(average age 66.4±12.1)and 15 patients in the control group(average age 67.1±12.8).The control group was only treated with conventional medicine without any training.At baseline,there was no significant difference between the two groups in age,left ventricular ejection fraction,risk factors for cardiovascular disease,and medication.According to the method of PIT training for coronary heart disease in the early stage of the research group,the maximal autonomous ischemic fist movement was adopted to produce the physiological ischemia of skeletal muscle.In the course of training,one of the patients with the hand grip was the most subjective effort to keep clenching and timing.Each time,1 min was maintained for 1min,and the group was repeated 10 times for 1 group.Make another one with a clenched fist on the other side;There are 4 groups of 4 in the afternoon.Train 5d each week for 3 months.During exercise,the patient is asked to maintain natural respiration and avoid holding his breath.The vascular endothelial growth factor(VEGF)concentration was determined by ELISA.6 minutes walking test method: after eating 2 hours to begin the test.A 30-meter long straight line in the corridor on both sides of the ward led the patient to walk up and down the corridor as far as he could,and within six minutes he could finish as far as he could.Minnesota scale method of use: MLHFQ has 21 items,measuring quality of life from three areas: namely the body field(item 2,3,4,5,6,7,12,13),emotional field(item 17,18,19,20,21)(entry 1,8,9,10,11,14,15,16)and other areas.Each item of MLHFQ is 0-5 points and 6 segments.The original score of each item is 0(best),and the highest score is 5(worst).Each entry adds up to a total score,so the overall score is 0(best)-105(worst).The higher the score,the worse the quality of life.The lower the score,the better the quality of life.To observe the training safety of physiological ischemia training from heart rate,blood pressure changes and absence of myocardial ischemia.Compared to the Minnesota heart failure scale(after baseline-12 weeks),the 6-minute walking distance and the number of VEGF concentrations before and after the training.ResultsDuring PIT training,the heart rate and blood pressure were within the range of safety;There was no obvious myocardial ischemia and dizziness.Before the training,there was no significant difference in VEGF concentration in peripheral blood between the training group and the control group at baseline level,no statistical significance,P>0.05.After 12 weeks of clenched fist training,the VEGF concentration in the training group increased significantly(P<0.01);before and after training was significantly different in the training group(P<0.05)after PIT training,There was no statistically significant difference between VEGF concentration in the control group(P>0.05).The indicators of the Minnesota heart failure scale decreased significantly after exercise(P<0.05);6 minute walking distance was increased(P<0.05).There was no significant difference in the control group(P>0.05).ConclusionPhysiological ischemia training may promote remote ischemic myocardium by VEGF release collateral circulation formation,thus improve exercise capacity in patients with coronary heart disease with heart failure,at the same time improve the quality of life in patients with heart failure.