2016


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2016/№4

Changes in parameters of intracardiac hemodynamics during rehabilitation of patients with arterial hypertension

Sumin A. N.1, Shushunova O. V.2, Arkhipov O. G.2
1 – Federal State Budgetary Institution, “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002
2 – Federal Budgetary Institution, Rehabilitation Center “Topaz”
of the RF Social Insurance Fund, Leskhoznaya 1, Myski 652840, Kemerovo Region

Keywords: hyperpiesis, rehabilitation, echocardiography

DOI: 10.18087 / rhj.2016.4.2197

Background. Both evaluation of heart rhythm variability and EchoCG data, primarily indexes of LV and RV diastolic function, can be used for monitoring of rehabilitation programs effectiveness. However, it is unclear how these data correlate with each other. Aim. To evaluate time-related changes in EchoCG indexes of LV and RV during rehabilitation of patients with AH. Materials and methods. The study included 50 patients with stage 1–3 essential hypertension aged 58.0 (54.0–62.0). Instrumental examinations, including ECG, EchoCG, and cardiointervalography using the diagnostic system ORTO expert, were performed for all patients. Based on results of repeated cardiointervalography, patients were divided into two groups: group 1 with improved adaptation in the course of rehabilitation program (n=24) and group 2 without improved adaptation (n=26). Results. In group 1, the number of patients with satisfactory adaptation and adaptation tension without adaptation failure was considerably increased. In group 2, in contrast, the number of patients with failed adaptation was increased, the number of patients with adaptation tension was decreased, and patients with satisfactory adaptation were absent (Z=5.68; р<0.0001). In the group with impaired adaptation, the early mitral flow propagation velocity (Vp) was significantly increased by 13.5 % (р=0.009) and  the tricuspidal flow propagation velocity (Vpt) was increased by 9.3 % (р=0.026) although these parameters did not significantly differ between the groups in repeated tests. We observed a significant initial decrease in the early motion of septal mitral annulus, e’sept (p<0.05), in group 1, which did not differ between the groups in the repeated test. The early motion velocity of lateral mitral annulus e’ was increased by 9 % (р=0.0058), the е’ / а’ value – by 33 % (р=0.008), and the velocity s’ – by 10 % (р=0.039) in the group without adaptation improvement. In contrast, in the group with improved adaptation, the systolic motion velocity of tricuspid valve was significantly decreased by 6.3 % (р=0.026) and its late diastolic motion – by 11.2 % (р=0.013) in the course of rehabilitation program; moreover, the late diastolic motion of tricuspid valve was significantly lower in patients with improved adaptation than in patients of group 2 (p<0.05) in the repeated test. Conclusion. After a course of sanatorium rehabilitation, evaluation of heart rhythm variability by the active orthostatic test (AOT) showed improved adaptation in 48 % of patients. In the absence of changes or impaired adaptation, the sympathetic activity was increased both at rest and in response to AOT. This group also showed improved indexes of LV and RV filling, including the propagation velocity of early transmitral (р=0.009) and transtricuspid (р=0.026) flows and the е’ / а’ ratio of mitral annulus (р=0.008). These results underline a need for comprehensive evaluation of rehabilitation program efficacy in patients with AH including parameters of both EchoCG and autonomic balance.
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Sumin A. N., Shushunova O. V., Arkhipov O. G. Changes in parameters of intracardiac hemodynamics during rehabilitation of patients with arterial hypertension. Russian Heart Journal. 2016;15 (4):276–283

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