Динамика маркеров повреждения миокарда в периоперационном периоде коронарного шунтирования в зависимости от программы преабилитации

Aim . To evaluate the morphological and functional cardiac parameters and to measure markers of myocardial injury in the perioperative period of patients undergoing coronary artery bypass grafting (CABG), depending on the prehabilitation program. Methods . 60 male patients with stable coronary artery disease (CAD) underwent screening in the preoperative period and were randomized into two groups. Group 1 (n = 30) underwent supervised treadmill exercises at intensity corresponding to 80% of VO2 peak during the preoperative management. Group 2 (n = 30) patients did not undergo any additional trainings. Patients underwent a standard echocardiographic (ECHO-CG) study in the preoperative period and at days 5-7 after CABG. Serum markers of myocardial injury (troponin I, NT-proBNP) were measured in both groups of patients in the preoperative period before training (measurement 1), at the end of exercise training sessions (measurement 2) and at days 5-7 (measurement 3) after CABG. Results. ECHO-CG findings reported that left ventricular end-systolic dimension (p = 0.039) and left ventricular end-systolic volume (p = 0.039) increased by 8.5% and 18% in patients who underwent supervised exercise trainings as compared to the baseline values. An increase in these parameters was more pronounced in the control group (17% (p = 0.00029) and 41% (p = 0.00028), respectively). NT-proBNP levels showed a downward trend in patients with prehabilitation at the end of the training sessions, while in the control group NT-proBNP levels increased. An increase in NT-proBNP levels was reliable in patients without exercise trainings (p = 0.003) after CABG compared to the preoperative values, while NT-proBNP levels did not differ significantly in patients who underwent prehabilitation (p>0.05). Conclusion . The safety of high-intensity exercise trainings in the prehabilitation program for CABG had been confirmed by laboratory markers of myocardial damage. The obtained data proved the efficiency of active prehabilitation for optimizing echocardiographic parameters and inducing cardioprotection.