PROHLÍŽENÍ ABSTRAKTA

COMPARISON OF THE EFFECTS OF TWO REHABILITATION TRAINING PROGRAMS ON ARTERIAL STIFFNESS IN PATIENTS WITH CHRONIC HEART FAILURE Tématický okruh: Srdeční selhání, transplantace, oběhové podpory
Typ: Ústní sdělení - lékařské , Číslo v programu: 155
Sdělení navržené do bloku Asociace/PS/OS: PS Kardiovaskulární rehabilitace

Dobšák P.¹, Frantisová M.², Sosíková M.², Homolka P.², Špinarová L.³, Vítovec J.⁴, Kohzuki M.⁵, Saner H.⁶, Soška V.⁷, Siegelová J.⁸ ¹ Klinika tělovýchovného lékařství a rehabilitace LF MU, FN U sv. Anny, Brno, ² Klinika tělovýchovného lékařství a rehabilitace LF MU, FN u sv.Anny v Brně, Brno, ³ I. interní kardioangiologická klinika LF MU, FN u sv.Anny v Brně, Brno, ⁴ I. interní kardioangiologická klinika LF MU, FN u sv. Anny, Brno, ⁵ Department of Internal Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan, ⁶ Department of Cardiovascular Prevention and Rehabilitation, Swiss Cardiovascular Centre, Bern, Switzerland, ⁷ II. interní klinika LF MU, FN u sv.Anny, Brno, ⁸ Katedra fyzioterapie a rehabilitace LF MU, FN u sv. Anny v Brně, Brno
Neuromuscular electrical stimulation (NMES) of leg muscles has been introduced in clinical practice as a rehabilitation (RHB) method in patients with chronic heart failure (CHF); however, the role of NMES on the reduction of arterial stiffness and improvement of autonomic imbalance in these patients has not yet been studied. Sixty-four patients with stable CHF (mean age 57±7.2 years; mean ejection fraction 31±6.2%, NYHA II–III) were randomly assigned into two groups. Patients in a) exercise training group (ET; n=31) underwent 12 weeks of bicycle ET (3 x 40 min/week), and in b) group NMES (n=33) performed 12 weeks of NMES of quadriceps and calf muscles at home (10Hz, mode “20s on – 20s off”, intensity 60mA) 2 x 60 min/day. Non-invasive assessment of arterial wall stiffness was done using the cardio-ankle vascular index (CAVI). CAVI and heart rate variability (HRV) and VO2peak were evaluated before and after RHB program. Both types of RHB reduced significantly CAVI (in ET group from 9.6±2.7 to 8.9±2.2; P<0.02; in NMES group from 9.3±3.1 to 8.7± 3.2; P<0.02), increased high frequency (HF) component of HRV (+55.7%; P=0.01) and decreased ratio of low-frequency (LF) component with HF component (LF/HF ratio) in group ET (-41.4%; P<0.02). Changes of HRV parameters in group NMES were not significant; however, a marked tendency to autonomic stabilization was present. Both types of RHB led also to significant increase of VO2peak (in ET group from 19.1±3.2 to 20.9 ±2.7 mL/kg/min, P<0.01; in NMES group from 18.7±2.4 to 19.2±2.7 mL/kg/min; P<0.04). ET or NMES has been shown to improve significantly arterial stiffness and to stabilize autonomic balance in patients with moderate grade of CHF.