Effects of the Cardiac Rehabilitation Program on the Myocardial Performance Index in Patients With a History of Coronary Artery Bypass Surgery

Document Type: Original Article

Authors

1 Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran.

2 Department of Epidemiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran.

Abstract

Background: Cardiac rehabilitation (CR) programs effectively decrease mortality and lead to a better quality of life. Our study addresses the effects of these programs on the myocardial performance index (MPI) as a marker of cardiac function in post-bypass patients. To evaluate the effects of CR on the MPI as a quantitative cardiac function index according to different baseline characteristics including the left ventricular ejection fraction, we designed this cohort before-and-after trial.
Methods: We enrolled 65 outpatients with a history of coronary artery bypass surgery (CABG). The MPI and ejection fraction indices were measured before and after the completion of an individualized 12-session CR program.
Results: After the successful completion of a CR program by the subjects, the mean MPI showed a significant decline (0.50 vs 0.55; P < 0.001) and the left ventricular ejection fraction exhibited a significant rise (P < 0.001). The change was more pronounced specifically in the group with a moderately reduced left ventricular dysfunction (mean MPI = 0.52 vs 0.63).
Conclusions: We successfully showed that a supervised individualized CR program can affect the MPI and systolic ejection fraction indices in post-bypass patients positively. Thus, an individualized CR program should be considered for this group of patients as a complement to the standard therapy.

Keywords


1. Serruys PW, Morice MC, Kappetein AP,
Colombo A, Holmes DR, Mack MJ, et al.
Percutaneous coronary intervention versus
coronary-artery bypass grafting for severe
coronary artery disease. The New England
journal of medicine. 2009 Mar 5;360(10):961-
72.

2. Serruys PW, Morice MC, Kappetein AP,
Colombo A, Holmes DR, Mack MJ.
Percutaneous coronary intervention versus
coronary-artery bypass grafting for severe
coronary artery disease. The New England
journal of medicine. Mar 5;360(10):961-72.
3. Gharib M. Rehabilitation in coronary heart
disease. Tehran: In 12th Cardio-vascular
Congress; 2001.
4. Lie I, Arnesen H, Sandvik L, Hamilton G,
Bunch EH. Effects of home based intervention
program on anxiety and depression 6 months
after coronary artery bypass grafting. J
Psychosomatic Res. 2007; 62(4):411-8.
5. Davoud Vand ShM, Elahi N, Ahmadi F,
Haghighi Zadeh MH. Effectiveness of the shortterm cardiac rehabilitation programs on the rate
of disease relapse again refer and
rehospitalization in patients with myocardial
infarction (Persian). J Rehab. 2008;9.
6. Menezes AR, Lavie CJ, Milani RV, Arena RA,
Church TS. Cardiac rehabilitation and exercise
therapy in the elderly: Should we invest in the
aged? Journal of Geriatric Cardiology : JGC.
2012 10/19/received 12/16/revised
12/23/accepted;9(1):68-75.
7. Stewart KJ, Badenhop D, Brubaker PH,
Keteyian SJ, King M. Cardiac rehabilitation
following percutaneous revascularization, heart
transplant, heart valve surgery, and for chronic
heart failure. Chest. 2003 Jun;123(6):2104-11.
8. Smith SC, Jr., Blair SN, Bonow RO, Brass LM,
Cerqueira MD, Dracup K, et al. AHA/ACC
Scientific Statement: AHA/ACC guidelines for
preventing heart attack and death in patients
with atherosclerotic cardiovascular disease:
2001 update: A statement for healthcare
professionals from the American Heart
Association and the American College of
Cardiology. Circulation. 2001 Sep
25;104(13):1577-9.
9. Taylor RS, Brown A, Ebrahim S, Jolliffe J,
Noorani H, Rees K, et al. Exercise-based
rehabilitation for patients with coronary heart
disease: systematic review and meta-analysis of
randomized controlled trials. Am J Med. 2004
May 15;116(10):682-92.
10. Vanhees L, Fagard R, Thijs L, Staessen J,
Amery A. Prognostic significance of peak
exercise capacity in patients with coronary
artery disease. Journal of the American College
of Cardiology. 1994 Feb;23(2):358-63.
11. Öcal B, Oğuz D, Karademir S, Birgen D,
Yüksek N, Ertem U, et al. Myocardial
Performance Index Combining Systolic and
Diastolic Myocardial Performance in
Doxorubicin-Treated Patients and Its
Correlation to Conventional Echo/Doppler
Indices. Pediatric Cardiology. 2014
2014//;23(5):522-7.
12. Tei C, Nishimura RA, Seward JB, Tajik AJ.
Noninvasive Doppler-derived myocardial
performance index: Correlation with
simultaneous measurements of cardiac
catheterization measurements. Journal of the
American Society of
Echocardiography.10(2):169-78.
13. Abd El Rahman MY, Abdul-Khaliq H, Vogel
M, Alexi-Meskischvili V, Gutberlet M, Hetzer
R, et al. Value of the new Doppler-derived
myocardial performance index for the evaluation
of right and left ventricular function following
repair of tetralogy of fallot. Pediatr Cardiol.
2002 Sep-Oct;23(5):502-7.
14. Dankner R, Geulayov G, Ziv A, Novikov I,
Goldbourt U, Drory Y. The effect of an
educational intervention on coronary artery
bypass graft surgery patients' participation rate
in cardiac rehabilitation programs: a controlled
health care trial. BMC Cardiovasc Disord.
2011;11:60.
15. Fiorina C, Vizzardi E, Lorusso R, Maggio M,
De Cicco G, Nodari S, et al. The 6-min walking
test early after cardiac surgery. Reference values
and the effects of rehabilitation programme.
European journal of cardio-thoracic surgery :
official journal of the European Association for
Cardio-thoracic Surgery. 2007 Nov;32(5):724-9.
16. Yu CM, Li LS, Lam MF, Siu DC, Miu RK, Lau
CP. Effect of a cardiac rehabilitation program on
left ventricular diastolic function and its
relationship to exercise capacity in patients with
coronary heart disease: experience from a
randomized, controlled study. Am Heart J. 2004
May;147(5):e24

2. Serruys PW, Morice MC, Kappetein AP,
Colombo A, Holmes DR, Mack MJ.
Percutaneous coronary intervention versus
coronary-artery bypass grafting for severe
coronary artery disease. The New England
journal of medicine. Mar 5;360(10):961-72.
3. Gharib M. Rehabilitation in coronary heart
disease. Tehran: In 12th Cardio-vascular
Congress; 2001.
4. Lie I, Arnesen H, Sandvik L, Hamilton G,
Bunch EH. Effects of home based intervention
program on anxiety and depression 6 months
after coronary artery bypass grafting. J
Psychosomatic Res. 2007; 62(4):411-8.
5. Davoud Vand ShM, Elahi N, Ahmadi F,
Haghighi Zadeh MH. Effectiveness of the shortterm cardiac rehabilitation programs on the rate
of disease relapse again refer and
rehospitalization in patients with myocardial
infarction (Persian). J Rehab. 2008;9.
6. Menezes AR, Lavie CJ, Milani RV, Arena RA,
Church TS. Cardiac rehabilitation and exercise
therapy in the elderly: Should we invest in the
aged? Journal of Geriatric Cardiology : JGC.
2012 10/19/received 12/16/revised
12/23/accepted;9(1):68-75.
7. Stewart KJ, Badenhop D, Brubaker PH,
Keteyian SJ, King M. Cardiac rehabilitation
following percutaneous revascularization, heart
transplant, heart valve surgery, and for chronic
heart failure. Chest. 2003 Jun;123(6):2104-11.
8. Smith SC, Jr., Blair SN, Bonow RO, Brass LM,
Cerqueira MD, Dracup K, et al. AHA/ACC
Scientific Statement: AHA/ACC guidelines for
preventing heart attack and death in patients
with atherosclerotic cardiovascular disease:
2001 update: A statement for healthcare
professionals from the American Heart
Association and the American College of
Cardiology. Circulation. 2001 Sep
25;104(13):1577-9.
9. Taylor RS, Brown A, Ebrahim S, Jolliffe J,
Noorani H, Rees K, et al. Exercise-based
rehabilitation for patients with coronary heart
disease: systematic review and meta-analysis of
randomized controlled trials. Am J Med. 2004
May 15;116(10):682-92.
10. Vanhees L, Fagard R, Thijs L, Staessen J,
Amery A. Prognostic significance of peak
exercise capacity in patients with coronary
artery disease. Journal of the American College
of Cardiology. 1994 Feb;23(2):358-63.
11. Öcal B, Oğuz D, Karademir S, Birgen D,
Yüksek N, Ertem U, et al. Myocardial
Performance Index Combining Systolic and
Diastolic Myocardial Performance in
Doxorubicin-Treated Patients and Its
Correlation to Conventional Echo/Doppler
Indices. Pediatric Cardiology. 2014
2014//;23(5):522-7.
12. Tei C, Nishimura RA, Seward JB, Tajik AJ.
Noninvasive Doppler-derived myocardial
performance index: Correlation with
simultaneous measurements of cardiac
catheterization measurements. Journal of the
American Society of
Echocardiography.10(2):169-78.
13. Abd El Rahman MY, Abdul-Khaliq H, Vogel
M, Alexi-Meskischvili V, Gutberlet M, Hetzer
R, et al. Value of the new Doppler-derived
myocardial performance index for the evaluation
of right and left ventricular function following
repair of tetralogy of fallot. Pediatr Cardiol.
2002 Sep-Oct;23(5):502-7.
14. Dankner R, Geulayov G, Ziv A, Novikov I,
Goldbourt U, Drory Y. The effect of an
educational intervention on coronary artery
bypass graft surgery patients' participation rate
in cardiac rehabilitation programs: a controlled
health care trial. BMC Cardiovasc Disord.
2011;11:60.
15. Fiorina C, Vizzardi E, Lorusso R, Maggio M,
De Cicco G, Nodari S, et al. The 6-min walking
test early after cardiac surgery. Reference values
and the effects of rehabilitation programme.
European journal of cardio-thoracic surgery :
official journal of the European Association for
Cardio-thoracic Surgery. 2007 Nov;32(5):724-9.
16. Yu CM, Li LS, Lam MF, Siu DC, Miu RK, Lau
CP. Effect of a cardiac rehabilitation program on
left ventricular diastolic function and its
relationship to exercise capacity in patients with
coronary heart disease: experience from a
randomized, controlled study. Am Heart J. 2004
May;147(5):e24