Features Of Cardiopulmonary Function Change For Patients With ACS In Early Stage Of Cardiac Rehabilitation After PCI

BackgroundCardiopulmonary exercise testing(CPET) is a non-invasive and objective method of evaluating both cardiac and pulmonary function through recording the metabolism index,ventilation index and variation of EEG under certain load.It reflects the change of cellular respiration function.Nowadays,It has been widely used in cardiovascular domain,like evaluating prognosis of heart failure,application in cardio-exercise rehabilitation.And the attention paid to estimate the curative effects of percutaneous coronary intervention(PCI) has been increasing.There's lots of reports about the improving cardiorespiratory capability by contrast the CPET before and after PCI,but nearly no report relate to the features of cardiopulmonary reserve between the unstable angina(UA) or ST-element myocardial infarction(STEMI) in early stage of cardiac rehabilitation after PCI.In our study,we want to investigate the character and difference of the UA and STEMI patients in early stage of cardiac rehabilitation after PCI.MethodsWe randomly enrolled 26 patients of acute coronary syndromes(divided into UA group and STEMI group) after PCI,who take the CPET in 6 weeks from April 2006 to November 2008.And enrolled 14 patients with less than 40%stegnosis of involved coronary and no PCI treatment,as a control group.The ACS patients were all treated by PCI and normalize medication,while the control group only treated by normalize medication.1.Contrast the difference in clinical baseline,measured value/predicted value of VO2 peak,VO2 AT,O2 pulse,VT,VD/VT rest,VD/VT Peak;METs,HRR, TET,VE/VCO2,LVEF and LVEDd between the UA group,STEMI group and control group.2.Contrast the clinical baseline,coronary visualization,LVEF,LVEDd and CPET index between the UA group and STEMI group.Results:1.Result of baseline1.1 By contrast the UA group and STEMI group separately with control group,we find there're no difference in the age,TG,TC LDL-C,HDL-C,BMI,morbidity rate of hypertension,fasting blood glucose,morbidity rate of DM and smoking rate(P＞0.05),except fasting blood glucose in contrast of STEMI group and control group(P＜0.05).1.2 Rates of patients achieved the goal exercise intensity(RER＞1)in the UA group,STEMI group and the control group have no significant meaning(P＞0.05).And no one in the CPET underwent syncope,malignant arrhythmia,accident and death.1.3 We find there're statistical distinctions in the fasting blood glucose,the morbidity rate of DM and the smoking rate(P＜0.05).But there're no difference in the age,TG,TC,LDL-C,HDL-C,BMI and morbidity rate of hypertension(P＞0.05).1.4 We contrast the lesion category of coronary,like lesion of 2-3 coronary,lesion of LAD and lesion of RCA or LCX between the UA group and the STEMI group.There's no difference inχ~2-test(P＞0.05).2.Result of cardiopulmonary function index2.1 We find VO2 AT%pred,METs and TET in control group are all higher than those in UA group and STEMI group(P＜0.05),but other index show no difference (VO2peak%pred,VO2%pred,VO2 AT%pred,O2 pulse%pred,VT %pred,VD/VT rest%pred,VD/VT Peak%pred,VE/VCO2 AT and HRR) (P＞0.05).The LVEF and LVEDd are different between the STEMI group and control group(P＜0.05),but have no variance in the contrast of the UA group and control group(P＞0.05).2.2 We find no significant difference in LVEF and LVEDd between the UA group and the STEMI group(P＜0.05).But no distinction is found in LVEF.LVEDd,VO2 peak,VCO2,VO2 AT,VE/VCO2 AT,RER,VD/VT rest,VD/VT peak,O2 pulse,HRR and METs.But the VE/VCO2 AT in STEMI group tends to lower than that of UA group.And there's significant drop from VD/VT PEAK to VDNT Rest in paired t-test(P＜0.01).Conclusions1.Contrast with the coronary atherosclerosis patients(control group),the ACS patients has lower cardiopulmonary reserve which is characterized by significant decline in VO2 AT%pred,TET and METs while no obviously difference in respiratory reserve indexes.TET and METs represent the toleration of exercise,while AT and VO2 are sensitive index of cardiac reserve.The lower level of TET,METs and VO2 AT demonstrates the lower load of exercise and worse cardiopulmonary reserves are mainly due to the shortness of the cardiac reserve.2.The STEMI patients have worse rest left ventricular systolic function than UA patients,but no difference in cardiopulmonary reserve during exercise in early stage of cardiac rehabilitation after PCI.And the VE/VCO2 AT in STEMI group is tend to lower than that of the UA group.So,it indicates the STEMI patients gain more benefits in cardiopulmonary reserve in early stage of cardiac rehabilitation after PCI, which illus PCI is valuable in the STEMI patient for cardiopulmonary reserve's improving.3.CPET is a ideal approach to evaluate the cardiopulmonary capability for the ACS patient in early cardiac rehabilitation after PCI for its convenience,safety, easy-to-use,good reproducibility and objectivity.