DYNAMICS OF MORPHOFUNCTIONAL STATUS OF THE MYOCARDIUM IN CARDIOR REHABILITATION PATIENTS AFTER THE ACUTE CORONARY SYNDROME DEPENDING ON SMOKING FACTOR
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i1.12933Keywords:
acute coronary syndrome, smoking, cardiorehabilitation, morphofunctional state, LV remodelingAbstract
SUMMARY. The article presents the results of the dynamics of the morphofunctional state of the myocardium in patients with acute coronary syndrome (ACS), at the stage of sanatorium cardiorehabilitation (CR), depending on the status of the smoker.
The aim – study the dynamics of LV remodeling, local contractility and LV myocardial function in rehabilitation patients with a history of ACS depending on smoking factor.
Material and Methods. 114 patients at the age of 42–68 years old (average age 57.40±5.8) that have recently had ACS (not more than 1 month ago) have been examined and have passed cardiac rehabilitation programme in the rehabilitation department after cardiac diseases at “Morshynkurort” sanatorium-resort complex. All patients have been divided into 2 groups according to smoking habit. Patients with smoking factor (smokers, n=64, average age 54.94±1.6 years old) belonged to the 1st group, patients without smoking factor (non-smokers, n=50, average age, 58.64±1,4 years old) belonged to the 2nd group. The 1st group was divided into 2 subgroups in the end of resort rehabilitation in order to evaluate dynamic of researched indices: IA – smokers (n=36), that gave up smoking during the process of cardiac rehabilitation (CR), and IB – smokers (n=28) that continued smoking. The smoking index was calculated according to the formula: (SІ) = N * E / 20, where N is the number of cigarettes smoked (per day), E is smoking experience (years).
Results. The analysis of ultrasound indicators at the beginning of the CR program revealed that in the group of rehabilitation patients-smokers (I) LV CRD, LVD CRC, MM and BMI were significantly higher, and LV EF – significantly lower compared to non-smokers (II). A similar trend was observed in the analysis of calculated ultrasound indicators, including the Tei index, sphericity index and asynergy index, which were significantly higher in the group of smokers at the start of rehabilitation treatment. Analysis of the structure of LV geometry types showed that eccentric LV hypertrophy predominated in the group of smokers (I) (56 %), and concentric LV hypertrophy prevailed in the group of rehabilitation non-smokers (52 %). Estimation of the dynamics of the average values of ultrasound indicators on the 24th day of rehabilitation treatment showed the most pronounced positive changes in the functional capacity of the left ventricular myocardium in the group of smokers who successfully quit smoking (IA).
Conclusions. Smoker status significantly worsens the morphofunctional state of the myocardium in patients with a history of ACS, so it needs special attention when planning a program of sanatorium CR. Successful smoking cessation significantly improves the effectiveness of sanatorium CR, which is confirmed by an effective increase in segmental contractility and functional capacity of the left ventricular myocardium in the dynamics of cardiorehabilitation treatment. Smoking cessation programs should have a systematic approach and need to be improved in order to significantly reduce rehospitalization rates after discharge and rehabilitation programs.
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