Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

• We aimed to identify the effect of cardiac rehabilitation on the ischemic burden in patients with ischemic heart disease who are not candidate for coronary revascularization.
• Stress myocardial perfusion imaging (SPECT) was evaluated before and after enrollment in cardiac rehabilitation (CR) program in our institute.
• The difference between the SPECT-derived summed segmental scores at peak stress and at rest (SDS) was significantly lower after cardiac rehabilitation indicating that CR decreases the ischemic burden.

BackgroundIschemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability.AimWe aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization.MethodsThe study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study.ResultsThe mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT-derived summed segmental scores at peak stress and at rest (SDS) was significantly lower after CRP (4.4 ± 3 vs. 7.2 ± 3, p < 0.001).ConclusionParticipation in cardiac rehabilitation program improves ischemic burden in patients with IHD who are unfit or not suitable for conventional cardiac revascularization. In addition the decreased ischemic burden, functional capacity, hemodynamic and metabolic profiles also improve for this group of patients and thus, cardiac rehabilitation should be implemented for routine management of those patients.