Background. Exercise capacity is strongly associated with morbidity, as well as all-cause and cardiovascular mortality in patients with heart failure. Right ventricular dysfunction (RVD) appears to be an independent predictor of exercise intolerance, but its influence on patients’ exercise capacitiy in the early period after myocardial revascularization remains unclear. Purpose: evaluation of exercise capacity in patients with DVD 3 months after myocardial revascularization. Methods. The research is a prospective analytical study which is part of the scientific project „ALTERICC” within the State Program 2020-2023. The research included 114 patients 3 months after myocardial revascularization by coronary artery by-pass grafting or percutaneous coronary angioplasty. They were divided into 2 groups according to the presence of RVD: Gr. RVD - 35 patients and Gr. non-RVD -79 patients. All patients were investigated by echocardiography, cardiopulmonary exercise testing (CPET) and 6 minute walking test (6MWT). Results. Peak oxygen consumption (VO2p) achieved by patients in the RVD group was significantly lower (1018.0±400.6 ml/min) compared to those in the non-RVD group (1243.9±336, 6 ml/min), p<0.05. VO2p related to the maximum predicted value (VO2p%) was inferior in patients with RVD (49.2±13.3% vs 58.5±15.0%), p=0.01, as well as VO2p related to body mass was lower in the RVD group (VO2p/kg - 11.9±3.9 ml/min/kg vs 14.6±4.1 ml/min/kg), p=0.01. S’ RV and TAPSE correlated positively and statistically significantly with VO2p, VO2p% and VO2p/kg. Patients with RVD performed a lower distance during 6MWT (313.5±72 m vs 338.1±65.5 m). However, the results of 6MWT correlated positively with the work rate performed during CPET and VO2p, VO2p/kg, VO2p%. Conclusion. Exercise capacity (expressed both by maximal work rate and by VO2p, VO2p/kg, VO2p%, but also by the distance performed during TM6M) was lower in patients with RVD at 3 months after myocardial revascularization

Background. Heart failure (HF) is a well-defined risk factor for early mortality and morbidity after cardiac surgery.We aimed to analyze the evolution of the clinical phenotype of HF at an early stage after heart surgery.Methods. The study included 126 consecutive patients with established chronic HF who fulfilled the cardiac rehabilitation program after undergoing heart surgery (62.23±8.59 years, 67.5% - men). Subjects were divided into 3 groups according to the clinical phenotype of HF: group 1 - HF with reduced left ventricular (LV) ejection fraction (EF) (HFrEF), group 2 - HF with mildly reduced LV EF (HFmrEF) and group 3 - HF with preserved LV EF (HFpEF). All patients were investigated by electrocardiography, transthoracic echocardiography, 6 minutes walk test and assessment of serum NT-proBNP level. Results. Preoperatively, 23.9% of patients had HFrEF, 24.8% - HFmrEF and 51.3% - HFpEF. Analyzing the evolution of the HF phenotype in the early postoperative period, we found that most patients remained in the same group. However, among patients with preoperative HFmrEF, in 22.2% of patients there was an increase in LV EF over 50% and in 22.2% of patients was determined a reduced LV EF, p<0.001. The most obvious positive dynamic of the HF phenotype was attested in patients with HFrEF, where 37% of them presented a mildly reduced LV EF postoperatively, p <0.001. 78.9% of individuals with HFpEF remained in the same group, but 21% showed a decrease in LV EF, p<0.001. Conclusions. At the early stage after cardiac surgery, the most positive evolution of HF phenotype was noticed in the group of patients with HFrEF. Of the 44.4% of patients with HFmrEF who switched to another HF phenotype, only a half reported an increase in LV EF over 50%. The vast majority of patients with HFpEF had the same HF phenotype postoperatively.

A lot of studies have demonstrated the the cardiac rehabilitation program enhanced results in ischemic patients and was associated with a reduction in mortality in the post-myocardial period. The mechanisms of these in certain aspects of cardiac function, either systolic or diastolic are not fully understood. These studies have reported an increase in stroke volume and left ventricular ejection fraction as well as a decrease in heart rate and diastolic arterial pressure. In the present study, we aimed to evaluate the effect of the cardiac rehabilitation program on patients who underwent PCI by measuring and comparing their diastolic function as well as ventricular dimensions with those of un-rehabilitated patients who underwent PCI.