No abstract

Regardless of the management regime for heart failure (HF), there is strong evidence supporting the early implementation of exercise-based cardiac rehabilitation (CR). Respiratory therapy is considered to be an integral part of such secondary prevention protocols. The aim of the study was to evaluate the effect of inspiratory muscle training (IMT) on exercise tolerance and the functional parameters of the respiratory system in patients with heart failure involved in cardiac rehabilitation. The study included 90 patients with HF who took part in the second-stage 8-week cycle of cardiac rehabilitation (CR). They were randomly divided into three groups: Group I underwent CR and IMT; Group II only CR; and patients in Group III underwent only the IMT. Before and after the 8-week cycle, participants were assessed for exercise tolerance and the functional parameters of respiratory muscle strength. Significant statistical improvement concerned the majority of the hemodynamic parameters, lung function parameters, and respiratory muscle strength in the first group. Moreover, the enhancement in the exercise tolerance in the CR + IMT group was accompanied by a negligible change in the HRpeak. The results confirm that the addition of IMT to the standard rehabilitation process of patients with heart failure can increase the therapeutic effect while influencing some of the parameters measured by exercise electrocardiography and respiratory function.

One of the earliest detectable abnormalities in patients with coronary artery disease is left ventricular diastolic dysfunction. Its main cause is myocardial ischaemia, but still many of other mechanisms are possible. The aim of this study was to investigate the relation of cadmium, lead, copper, zinc, and selenium with left ventricular diastolic function indices in patients with coronary artery disease. The study included 33 patients (14 with single-vessel disease and 19 with multivessel disease on angiography) who were not exposed occupationally to heavy metals. Control group consisted of 18 patients with normal coronary arteries. The blood cadmium and lead concentrations and serum zinc, selenium and copper concentrations were determined using atomic absorption spectrophotometry. Left ventricular diastolic function parameters were estimated by echo-Doppler and colour M-mode. All heavy metal concentrations were within the standard ranges in all studied groups. Patients with single-vessel disease, multivessel disease and control group did not differ in concentrations of studied metals. On univariate and multivariate analysis only cadmium significantly correlated with echocardiographic parameters of left ventricular diastolic function: peak early to peak late mitral inflow velocity ratio (r = -0.36, p < 0.05) and deceleration time of early mitral inflow (r = 0.43, p < 0.01) in patients with CAD. No significant correlations between concentrations of heavy metals and indices of left ventricular diastolic function were found in control group. The present data suggest that cadmium in concentrations even below the threshold limit value for unexposed population may contribute to development of left ventricular diastolic dysfunction in patients with CAD, potentializing the effect of myocardial ischaemia.

Introduction: Women with IHD demonstrate lower quality of life and higher tendency to IHD related depression. Current CR programs are not as well suited to women's as men's needs. Men expect practical while women social and emotional assistance. Objectives: Use of Tai Chi exercises in outpatient CR of women with IHD increases its effectiveness leading to essential improvement of mental state. Aims: Valuation of effectiveness of different CR programs in quality of life (QoL) and depression level (DL) in women with IHD. Methods: Randomized, clinical trial included 68 women between 50 to 71 (average 62,07±6,00) with IHD confirmed by angiography and/or at least 1-2 months after myocardial infarction in stable disease, 24 MMSE points, EF>45%, no pharmacologically treated mental disorders. Patients participated in 12 weeks' CR program, in three groups: C-classical CR, P-classical CR and cognitive behavior psychotherapy, T-Tai Chi training. Stages: I-1-4 week-trainings 3 times/week, II-5-12 week-therapy in previous form, 2 times/week and 1 time/week cycloergometer. Evaluation of QoL and DL before the intervention, after 4 th and 12 th week, using Beck Depression Inventory and SF36 test examining physical (PCS) and mental (MCS) component summary of QoL. Results: In all valuations no statistical differences between the groups in DL and QoL. Only in T group confirmed improvement in both tests. MCS improved after 1 st and PCS after 2 nd CR stage. Conclusions: Supplementation of cardiac rehabilitation programs with Tai Chi elements has positive impact on QoL and depression level in women with IHD.