Early Cardiac Rehabilitation Improves Carotid Arterial Stiffness in Patients with Myocardial Infarction

Figures & data

Table 1 Baseline Clinical Characteristics of the Rehabilitation Group (Group B, Patients with Myocardial Infarction Subjected to Cardiac Rehabilitation) and Control Group (Group K, Patients with Myocardial Infarction Non-Subjected to Cardiac Rehabilitation)

	B n = 90	K n = 30	B vs K p
Age (years), Me [Q1-Q3]	66 [58–71]	67 [57–71]	0.901
Males, n (%)	62 (68.9)	19 (63.3)	0.574
BMI (kg/m^2), Me [Q1-Q3]	26.8 [25.2–29.4]	28.5 [26.5–30.8]	0.064
Arterial hypertension, n (%)	60 (67.4)	21 (70.0)	0.793
Diabetes mellitus, n (%)	24 (26.7)	8 (26.7)	1.000
Smokers, n (%)	22 (24.4)	10 (38.5)	0.763
SBP (mm Hg), Me [Q1-Q3]	121 [117; 132]	124 [117; 145]	0.427
DBP (mm Hg), Me [Q1-Q3]	78 [71; 84]	81 [71; 86]	0.271
MAP (mm Hg), Me [Q1-Q3]	93 [86; 100]	95 [90; 104]	0.296
PP (mm Hg), Me [Q1-Q3]	44 [38; 51]	45 [37; 54]	0.783
History of myocardial infarction, n (%)	6 (6.7%)	7 (23.3%)	0.011
LVEF (%)	49.3±8.5	46.6±11.2	0.238
Current treatment:
Beta-adrenolytic agents, n (%)	87 (96.7%)	28 (93.3%)	0.598
ACEI, n (%)	84 (93.3%)	26 (86.7%)	0.266
ARB, n (%)	5 (5.6%)	2 (6.7%)	1.000
Calcium channel blockers, n (%)	17 (18.9%)	11 (36.7%)	0.046
Diuretics, n (%)	24 (26.7%)	12 (40%)	0.168
Nitrates, n (%)	3 (3.3%)	0 (0.0%)	0.572
MRA, n (%)	24 (26.7%)	0 (0.0%)	<0.001
Clopidogrel, n (%)	41 (45.6%)	21 (70%)	0.035
Acetylsalicylic acid, n (%)	90 (100%)	30 (100%)	1.000
Ticagrelor, n (%)	48 (53.3%)	(23.3%)	0.008
Statins, n (%)	90 (100.0%)	30 (100.0%)	1.000

Note: Bold font denotes differences significant at p < 0.05.

Abbreviations: B, rehabilitation group; K, control group; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; MAP, mean arterial pressure; PP, pulse pressure; ACEI, angiotensin-converting-enzyme inhibitors; ARB, angiotensin receptor blockers; MRA, mineralocorticoid receptor antagonists; Me, median (50%); Q1, lower quartile (25%); Q3, upper quartile (75%); n, number, p, significance level of the test.

Table 2 Correlations Between Baseline Parameters of Arterial Stiffness and Peak Exercise Capacity and Exercise Duration in the Rehabilitation Group Along with the Significance Levels

Baseline Stiffness Parameters	Peak Exercise Capacity (MET)		Duration of Exercise (s)
	Rho	p	Rho	p
Beta (-)	−0.26	0.04	−0.07	0.61
EP (kPa)	−0.25	0.06	−0.12	0.4
PWV-beta (m/s)	−0.29	0.03	−0.16	0.25
AC (mm^2/kPa)	0.16	0.24	0.11	0.43

Note: Bold font denotes differences significant at p < 0.05.

Abbreviations: Beta, Beta-stiffness index; EP, Peterson’s elastic modulus; PWV-beta, local one-point pulse wave velocity; AC, arterial compliance; MET, metabolic equivalents of task; s, seconds; p, significance level of the test; Rho, Spearman’s Rho correlation coefficient.

Table 3 Parameters of Arterial Stiffness in the Rehabilitation Group (Group B, Patients with Myocardial Infarction Subjected to Cardiac Rehabilitation) and Control Group (Group K, Patients with Myocardial Infarction Non-Subjected to Cardiac Rehabilitation) at the Baseline and Six Weeks Later, Along with the Significance Levels for Between-Group Comparisons

	B n = 90	K n = 30	B vs K p
Baseline:
Beta (-), Me [Q1; Q3]	7.4 [5.6; 8.8]	6.3 [5.5; 9.0]	0.322
EP (kPa), Me [Q1; Q3]	101 [77; 121]	86 [70; 116]	0.347
PWV-beta (m/s), Me [Q1; Q3]	6.1 [5.4; 6.7]	5.8 [5.1; 6.6]	0.364
AC (mm^2/kPa), Me [Q1; Q3]	0.8 [0.6; 1.0]	0.9 [0.7; 1.0]	0.104
After six weeks:
Beta (-), Me [Q1; Q3]	6.2 [4.7; 7.6]*	7.1 [6.0; 9.7]	0.016
EP (kPa), Me [Q1; Q3]	78 [64; 107]*	101 [84; 140]	0.001
PWV-beta (m/s), Me [Q1; Q3]	5.4 [4.9; 6.2]*	6.2 [5.6; 7.3]	0.001
AC (mm^2/kPa), Me [Q1; Q3]	0.9 [0.7; 1.1]*	0.8 [0.7; 1.0]	0.177

Notes: Bold font denotes differences significant at p < 0.05.*Denotes significant differences (p < 0.05) between parameters of CAS in rehabilitation group before and after cardiac rehabilitation.

Abbreviations: Beta, Beta-stiffness index; EP, Peterson’s elastic modulus; PWV-beta, local one-point pulse wave velocity; AC, arterial compliance; B, rehabilitation group; K, control group; Me, median; Q1, lower quartile; Q3, upper quartile; p, significance level of the test; n, number.

Table 4 Numbers (Percentages) of Patients with Different Outcomes of Cardiac Rehabilitation Presenting with the Baseline Predictors of Improvement in Arterial Stiffness, Along with the Results of Independence Tests, Odds Ratios (OR) and Their 95% Confidence Intervals

Predictors of Improvement in Arterial Stiffness Parameters	Outcome of Cardiac Rehabilitation				p-value for the Test	Odds Ratio OR (95% CI)
	Improvement n = 30		No Improvement n = 60
	n	%	n	%
Age ≤71 years	28	93.3%	47	78.3%	0.081	3.87 (0.81–18.4)
Female	11	36.7%	17	28.3%	0.573	1.46 (0.58–3.72)
BMI >26.6 kg/m^2	17	56.7%	32	53.3%	0.929	1.06 (0.44–2.58)
SBP ≤120 mm Hg	21	70.0%	23	38.3%	0.009	2.74 (1.05–7.14)
DBP ≤74 mm Hg	14	46.7%	16	26.7%	0.097	2.41 (0.96–6.02)
MAP≤ 98 mm Hg	23	76.7%	38	63.3%	0.300	1.90 (0.70–5.15)
PP ≤41 mm Hg	16	53.3%	19	31.7%	0.079	2.47 (1.00–6.07)
TC ≤222 mg/dl	25	83.3%	42	70.0%	0.267	2.14 (0.71–6.49)
HDL-C >49.4 mg/dl	14	46.7%	24	40.0%	0.706	1.31 (0.54–3.18)
LDL-C≤ 123 mg/dl	20	66.7%	32	53.3%	0.327	1.75 (0.70–4.36)
TG ≤225 mg/dl	27	90.0%	51	85.0%	0.744	1.59 (0.40–6.36)
NT-proBNP >227.8 pg/mL	19	63.3%	29	48.3%	0.263	1.85 (0.75–4.54)
CRP >3.2 (mg/l)	15	50.0%	21	35.0%	0.254	1.86 (0.76–4.53)
Arterial hypertension	17	56.7%	43	71.7%	0.123	0.52 (0.21–1.29)
Diabetes mellitus	10	33.3%	14	23.3%	0.448	1.64 (0.63–4.32)
Current smoker	11	36.7%	11	18.3%	0.099	2.58 (0.96–6.94)
LVEF ≤43%	12	40.0%	7	11.7%	0.005	5.05 (1.72–14.8)
NSTEMI	15	50.0%	27	45.0%	0.823	1.22 (0.51–2.94)
LZTW > 1	20	66.7%	30	50.0%	0.202	2.00 (0.80–4.98)
Anterior myocardial infarction	8	26.7%	13	21.7%	0.792	1.31 (0.48–3.63)

Note: Bold font denotes differences significant at p < 0.05.

Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; MAP, mean arterial pressure; PP, pulse pressure; TC, total cholesterol; LDL-C, LDL cholesterol; HDL-C, HDL cholesterol; TG, triglycerides; NT-proBNP, N-terminal pro-brain natriuretic peptide; CRP, C-reactive protein; LVEF, left ventricular ejection fraction; NSTEMI, non-ST-elevation myocardial infarction; LZTW, number of involved coronary arteries on coronarography; n, number; p, significance level of the test.