EFEKTI FIZIČKOG TRENINGA NA DVOJNI PROIZVOD I QT DISPERZIJU KOD BOLESNIKA SA PREŽIVELIM INFARKTOM MIOKARDA ‒ DA LI EJEKCIONA FRAKCIJA LEVE KOMORE IMA UTICAJA NA BENEFIT
Sažetak
Cilj ovog rada bio je da se utvrdi efekat fizičkog treninga na dvojni proizvod (eng. double product – DP) i QT disperziju kod bolesnika sa preživelim infarktom miokarda (eng. myocardial infarction – MI) i da se ispita da li ejekciona frakcija leve komore (eng. left ventricular ejection fraction – LVEF) ima uticaja na benefit od fizičkog treninga.
U studiju je bilo uključeno 375 bolesnika sa preživelim MI. Bolesnici su potom podeljeni u dve grupe ‒ u jednoj grupi bili su bolesnici uključeni u program fizičkog treninga (TG: 329 bolesnika), dok su drugu grupu činili bolesnici koji nisu trenirali (NTG: 46 bolesnika). Svim ispitanicima urađeni su ehokardiografski pregled, dvanaestokanalni EKG, korigovana QT disperzija (QTdc) i test opterećenja. Nakon toga, ispitanici iz TG uključeni su u program fizičkog treninga u trajanju od tri nedelje.
Redukovana ejekciona frakcija leve komore (eng. reduced left ventricular ejection fraction – RLVEF), manja od 40%, bila je prisutna kod 104 (31,6%) bolesnika u TG i kod 16 bolesnika (34,8%) u NTG. Na početku perioda praćenja, u TG nije bilo značajne razlike u vrednostima DP-a između bolesnika sa RLVEF-om i onih bez RLVEF-a (p-NS), dok su QTdc vrednosti bile značajno veće kod bolesnika sa RLVEF-om (p < 0,001). Posle tri nedelje, u TG uočena je značajna redukcija QTdc (103,6 ± 28,3 prema 96,1 ± 25,8 ms; p < 0,05) i DP-a (12,3 ± 1,8 prema 11,7 ± 1,3 otkucaja/min x mmHg x103; p < 0,01) kod bolesnika sa RLVEF-om. Značajna redukcija QTdc (65,7 ± 25,4 prema 58,6 ± 22,8 ms; p < 0,005) i DP-a (11,9 ± 2,2 prema 10,8 ± 1,6 otkucaja/min x mmHg x103; p < 0,001) zapažena je i kod bolesnika bez RLVEF-a. Nasuprot tome, u NTG nije bilo bitnijih promena.
Rezultati su pokazali da fizički trening ima povoljan uticaj na DP i QTdc kod bolesnika sa preležanim MI. LVEF-a ima značajan uticaj na benefit od fizičkog treninga, s tim što je benefit veći kod bolesnika bez RLVEF-a.
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