Effects of Phase II Comprehensive Cardiac Rehabilitation on Coronary Plaque Volume After Acute Coronary Syndrome

Abstract

SummaryThe present study aimed to determine the effects of phase II (PII) comprehensive cardiac rehabilitation (CR) on coronary plaque volume in patients after acute coronary syndrome (ACS).We assigned 46 patients with ACS who had undergone standard phase I CR into groups who proceeded with PII-CR (PII-CR; n = 21) and those who did not (non-PII-CR; n = 25). We then measured anthropometric parameters and daily physical activity using a pedometer for up to 60 days. The isokinetic strength of the knee extensor and flexor muscles and exercise tolerance were tested and non-culprit lesions were analyzed using volumetric intravascular ultrasound at baseline and 6 months later.Baseline characteristics did not significantly differ between the two groups and exercise tolerance was significantly improved in both. Waist size and fat weight were significantly decreased, and muscle strength was significantly increased in the PII-CR group but not in the non-PII-CR group. The percent change in plaque volume (primary endpoint) did not differ significantly between the two groups. The percent change in plaque volume was significantly and negatively correlated with daily physical activity.Although risk factors, muscle strength, and exercise tolerance were improved by PII-CR, plaque regression did not differ significantly between the two study groups. A significant correlation between percent change in coronary plaque volume and physical activity was observed. A comprehensive phase II-CR, including frequent supervised exercise sessions and a program encouraging an increase in daily physical activity, may reduce plaque volume in patients after ACS (UMIN000006038). (Int Heart J 2015; 56: 597-604) Key words: Intravascular ultrasound, Physical activity A cute coronary syndrome (ACS) is an important public health problem, and approximately 42,000 Japanese die of myocardial infarction every year. 1) Comprehensive cardiac rehabilitation (CR) is an established program for patients with ACS after treatment by coronary artery bypass grafting (CABG) and heart failure 2) that helps to modify coronary risk factors and improve quality of life.3,4) A metaanalysis has shown that CR reduces all-cause mortality by 20% and cardiac mortality by 25%.5) The mechanisms through which CR improves mortality risk are attributed to improvements in lipid profiles, glucose metabolism, neurohormonal factors, autonomic nerve system, endothelial function, and reduced vascular inflammation. Atherosclerotic plaque regression and/or stabilization are upstream for cardiovascular events. Indeed, previous findings suggest that multifactorial intervention could retard plaque progression and stabilization. 6,7) Editorial p.583Recent advances in coronary plaque imaging such as intravascular ultrasound (IVUS) enable the visualization of plaque morphology and accurate measurement of plaque volume. 8,9) Indeed, our and other studies have shown that statins significantly reduce plaque volume in patients with ACS and stable coronary artery disease (CAD). [10][11][12] However, th...

Visit-to-Visit Variability and Reduction in Blood Pressure After a 3-Month Cardiac Rehabilitation Program in Patients With Cardiovascular Disease

“…CR is a comprehensive therapy and can improve physical activity and psychological function, quality of life, and the prognosis in patients with CVD. [1][2][3][4][5][6][7] The prognostic value of blood pressure (BP) is based mainly on measurements obtained in a clinical setting. 7) High BP is a major risk factor for the onset and progression of CVD, 8) and exercise training has been shown to reduce BP in patients with hypertension (HTN).…”

Physical Activity

“…4) The study could not demonstrate a significant reduction of coronary plaques in subjects with PII-CR compared with those with non-PII-CR, possibly because of the small sample size or the insufficient frequencies of exercise in the group with PII-CR. However, this study also included other findings that may have a significant impact on the performance of CR.…”

Is It Possible to Distinguish Patients with Terminal Stage of Heart Failure by Analyzing Their Breathing Patterns?

“…[28][29][30] Cardiac rehabilitation reduced visceral adipose tissue in patients with chronic heart failure 31) and reduced the coronary plaque volume in patients with acute coronary syndrome. 32) Notably, exercise training in cardiac rehabilitation also reduced the duration of exercise oscillatory ventilation 33) and oscillation amplitude 34) without changing the cycle length in patients with chronic heart failure. Therefore, cardiac rehabilitation improves cardiopulmonary efficiency and functional capacity in patients with heart failure, and improves prognosis by improving oscillatory breathing and autonomic imbalance.…”