Cardiovascular Journal of Africa: Vol 32 No 3 (MAY/JUNE 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 3, May/June 2021 AFRICA 123
Comparison of the improvement of flow-mediated
dilatation in patients with acute coronary syndrome
versus stable angina after six-month cardiac
rehabilitation
In Hyun Jung, Jongkwon Seo, Gwang Sil Kim, Hye Young Lee, Young Sup Byun, Byung Ok Kim,
Kun Joo Rhee, Sung-Jin Hong, Chul Kim
Abstract
Background: We investigated whether the improvement in
endothelial function, measured using flow-mediated dila-
tation (FMD), an important predictor of cardiovascular
outcomes, was comparable in acute coronary syndrome
(ACS) versus stable angina patients after percutaneous coro-
nary intervention (PCI) and a six-month cardiac rehabilita-
tion (CR) programme.
Methods: We analysed the results from 119 patients who
completed a six-month CR programme after successful PCI
for stable angina (n = 50) and ACS (n = 69).
Results: After six months of CR, the results of FMD were
significantly improved in both groups. There were no signifi-
cant between-group differences in the FMD results at the
six-month follow up.
Conclusion: After successful PCI and a six-month CR
programme, FMD values were equally improved in both
stable angina and ACS patients.
Keywords: coronary disease, exercise training, endothelial function
Submitted 8/11/18, accepted 23/6/20
Published online 8/6/21
Cardiovasc J Afr 2021; 32: 123–128
DOI: 10.5830/CVJA-2020-022
Clinical results for cardiac rehabilitation (CR) for secondary
prevention indicate that CR can reduce cardiovascular risk
and event rates, foster healthy behaviours and promote active
lifestyles.1-5 The recent major evidence-based guidelines from
the American Heart Association and the American College of
Cardiology Foundation for the management and prevention of
coronary heart disease provides a class 1 level recommendation for
referral to a CR programme for patients with recent myocardial
infarction (MI) or acute coronary syndrome (ACS). Referral to
a CR programme is also recommended for patients with chronic
stable angina, heart failure, and for patients after coronary artery
bypass surgery or percutaneous coronary intervention (PCI).2
Impaired endothelium-dependent vasodilatation has been
linked to the pathogenesis of atherosclerotic vascular disease.
Endothelial dysfunction is an independent predictor of future
cardiovascular events in patients with cardiovascular disease.
The structural integrity of the endothelium is compromised
in patients with atherosclerosis. Endurance exercise training
improves nitrous oxide (NO) activity, oxidative stress,
inflammation and insulin resistance results.6-8
Both invasive and non-invasive methods have been used
for the evaluation of endothelial function, and flow-mediated
dilatation (FMD) is one of the accepted techniques used to
assess endothelial function.7,9,10 An abnormal FMD result is
associated with an increased coronary event risk in patients
with established coronary heart disease.6,8,11 However, only a
limited number of studies have been performed that evaluate
the effects of CR on the endothelial function of patients after
coronary revascularisation, and that compare the improvement
in endothelial function in patients with ACS or stable angina.
We investigated whether the improvement in endothelial
function, measured using FMD, was comparable in patients with
ACS or stable angina after PCI and a six-month CR period.
Methods
This was a single-centre registry study involving 119 patients who
had received CR after successful PCI for coronary artery disease
from January 2014 to June 2015. Only the patients who had
completed the planned CR programme after PCI were enrolled
in this study. This study was approved by the local institutional
review board.
Patients were excluded from the case series if they dropped
out of the CR programme, or if they had a history of prior
myocardial revascularisation, high degree of atrioventricular
(AV) block, severe aortic stenosis, systolic blood pressure > 200
mmHg or diastolic blood pressure > 110 mmHg at rest, left
Division of Cardiology, Department of Internal Medicine,
Yongin Severance Hospital, Yonsei University College of
Medicine, Yongin, Korea
In Hyun Jung, MD
Division of Cardiology, Department of Internal Medicine,
Sanggye-Paik Hospital, Inje University College of Medicine,
Seoul, Korea
Jongkwon Seo, MD,
Gwang Sil Kim, MD
Hye Young Lee, MD
Young Sup Byun, MD
Byung Ok Kim, MD, PhD,
Kun Joo Rhee, MD
Division of Cardiology, Department of Internal Medicine,
Severance Cardiovascular Hospital, Yonsei University
College of Medicine, Seoul, Korea
Sung-Jin Hong, MD
Department of Rehabilitation Medicine, Sanggye-Paik
Hospital, Inje University College of Medicine, Seoul, Korea
Chul Kim, MD