Cardiovascular diseases, particularly advanced coronary artery disease requiring interventions like Coronary Artery Bypass Grafting (CABG), are major global health concerns. Comprehensive cardiac rehabilitation (CR) is a crucial element in patient recovery, yet its effectiveness varies significantly. The main objective of this project is the comprehensive evaluation of the actual effectiveness of standard CR and the identification of multi-faceted factors-biological, functional, and psychosocial-that influence its outcomes and long-term prognosis.
Methodology and Study Design The project plans to recruit 150 male and female patients, aged 50-80 years, who are hospitalized in the cardiac rehabilitation ward, primarily following CABG surgery.
Assessments will be conducted at three key time points to monitor the dynamic nature of changes:
Baseline (T0): At the beginning of cardiac rehabilitation.
Post-Rehab (T1): At the conclusion of the standard rehabilitation program.
Follow-up (T2): Approximately 3-6 months after the patient's discharge.
Detailed Research Domains
The study will focus on several key domains to comprehensively assess the mechanisms underlying recovery:
A. Functional and Physical Assessment
Exercise Tolerance: Measured using the 6-Minute Walk Test (6MWT).
Physical Fitness and Strength: Assessed via Handgrip Dynamometry, the Barthel Scale for daily living activities, and the Tinetti Scale for balance and gait.
Body Composition: Detailed analysis using Bioelectrical Impedance Analysis (BIA) to track changes in muscle mass and fat tissue.
Diaphragm Function: Evaluation of diaphragm muscle thickness and mobility using Ultrasound (USG) to monitor respiratory improvement.
Postural Stability: Assessment of pressure distribution using a tensiometric mat (posturography).
B. Psychological and Neurocognitive Assessment
Mental Status: Evaluated using validated scales, including the WHO-5 Well-Being Index and the HADS Scale for anxiety and depression.
Cognitive Function: Screening for potential post-surgery cognitive impairment (memory, concentration) using the MoCA and MMSE scales.
C. Sleep Disorders and Biological/Hormonal Factors
Obstructive Sleep Apnea (OSA): Objective assessment of the frequency and severity of OSA using a portable sleep monitor.
Oral Health & OSA Risk: Detailed dental and craniofacial examinations to assess OSA risk factors related to the oral cavity status.
Hormonal and Biochemical Markers: Analysis of sex hormones (Testosterone, Estradiol) and their correlation with overall condition and rehabilitation response.
Myokines and Metabolic Signaling: Measurement of myokines (Irisin, Myostatin) and related proteins to understand mechanisms of exercise adaptation.
Standard Laboratory Tests: Including standard markers like lipid profile, glucose, HbA1c, CRP, homocysteine, and Vitamin D3.
Significance and Expected Outcomes The project aims to establish a patient profile that clearly identifies who benefits most from CR and who is at risk of poor outcomes. This identification of predictive factors will enable the early introduction of personalized interventions, such as targeted physical therapy, psychological support, or specialized diagnostics for sleep disorders. The ultimate goal is to optimize CR programs, maximizing gains in physical capacity, quality of life, and the long-term cardiac prognosis for patients.
