Aim To assess the tolerability of an individualized physical rehabilitation program (PRP) in inotrope-dependent patients with end-stage chronic heart failure (CHF). Material and methods This prospective randomized study included 120 men aged 18-65 years with left ventricular ejection fraction ≤30 % and blood pressure ≥90 / 60 mm Hg. Patients who have received dobutamine or dopamine for ≥2 weeks were randomized into two groups: group 1, 40 patients who participated in the PRP and group 2, 40 patients who did not participate in the PRP. Group 3 included 40 patients without inotropic support who participated in the PRP. Results Patients of groups 1 and 3 attended >80 % of the scheduled classes without developing life-threatening adverse events (AEs) associated with exercise (E). After 6 months of the study, the exercising patients achieved a comparable (average) E intensity: 44 [35; 50]% and 45 [40;52]% of heart rate reserve and Borg scale scores 14 [12; 14] and 13 [11; 14] in groups 1 and 3, respectively (p>0.05). Initially, after 3 and 6 months at the peak of physical activity in groups 1 and 3, there was no decrease in arterial blood oxygen saturation according to pulse oximetry (SpO 2 ) <93 %. At baseline, lactate levels in central venous blood at rest were normal in all groups. After 6 months, the lactate concentration was 1.1 mmol / l in group 1, 2.3 mmol / l in group 2, and 1.4 mmol / l in group 3 (р1-2=0.005; p2-3=0.008, respectively). At the E peak at baseline, after 3 and 6 months, comparable increases in lactate not exceeding 3 mmol / l were detected in groups 1 and 3. Conclusion The study allowed assessment of the tolerability of individualized PRP performed at the aerobic level of energy supply, in inotropic-dependent patients with CHF. Individualized 6-month PRP in inotropic-dependent patients with end-stage CHF, provided safety criteria are met, is well tolerated and does not increase the number of AEs associated with CHF and physical rehabilitation (PR). Continued inotropic support with dopamine or dobutamine should not be considered as a contraindication to PR in patients with CHF in the absence of E intolerance or life-threatening AEs.

Objective . To assess and compare the impact of physical training (PT) on functional and hemodynamic characteristics in patients with chronic heart failure (CHF) depending on continuous inotropic support. Design and methods . Prospective randomized study included 120 men aged 18–65, admitted to the Almazov National Medical Research Center (St Petersburg, Russia) from 2014 to 2019 due to decompensated CHF of III–IV functional class (FC), with left ventricular ejection fraction (LVEF) ≤ 30 %; blood pressure (BP) ≥ 90/60 mmHg (with or without inotropic therapy). Patients receiving dopamine or dobutamine for ≥ 2 weeks were randomized into two groups: group 1 participated in program of physical training (PPT), and group 2 did not participate in PPT. Patients of group 3 had CHF of III–IV class without inotropic therapy and participated in PPT. Initially, all groups were comparable by clinical, functional and hemodynamic parameters. The follow-up lasted 6 months. During months 3 and 6, hemodynamic parameters — BP and heart rate (HR), respiration rate (RR) at rest and peak of exercise, echocardiographic and central hemodynamics at rest, parameters at rest, number of arrhythmias were evaluated. Results . Patients of group 1, after 3 and 6 months, showed no increase in systolic (BPs) and mean BP (BPm) at peak of exercise, in contrast to patients of group 3 who demonstrated a significant increase in BPs (p ≤ 0,002) and BPm (p ≤ 0,005) after 3 months, and BPs (p ≤ 0,001) and BPm (p ≤ 0,002) after 6 months. By 6-month follow-up, intergroup analysis did not show significant changes in HR, LVEF, end-diastolic volume, stroke volume and pulmonary pressure. Initially, ECG monitoring showed a higher number of unstable ventricular tachycardia (VT) in group 1 compared with group 3 (p = 0,01), after 3 and 6 months in all groups the number of VT was comparable. During 6 months, implantable cardioverter defibrillator (ICD) shocks were compared in all groups: 2 per group (5 %). Conclusions . “Inotrope-dependent” survivors with CHF at peak of exercise did not significantly increase BPs and BPm in contrast to “inotrope-independent” patients. Individually developed aerobic PPT of low and intermediate intensity in “inotrope-dependent” survivors did not influence negatively on echocardiographic parameters, parameters of hemodynamics at rest and during the peak of exercise, did not increase mortality and number of life-threatening cardiac arrhythmias and ICD shocks.

Aim. To determine whether the skeletal muscle of patients with chronic heart failure (CHF) retains the ability to regenerate and grow; to compare the effectiveness of long aerobic trainings, calculated by an individualized method, and conventionally calculated trainings (VO2peak values), in relation to the severity of heart failure, exercise tolerance (ET), and ergoreflex activity (ERGO).Material and methods. The study included 297 patients with stable III functional class (FC) CHF, receiving optimal therapy. The presence of heart failure was found in all patients at least 6 months before the start of the study (age — 18-65 years, body mass index (BMI) — 19-28 kg/height, m2. Initially, the study performed a cardiorespiratory test (CRT) with an assessment of gas composition, acid-base balance of the blood and ERGO activity. Patients were randomized into 2 groups: experimental (EG) and control (CG). For EG, based on the determination of the lactate threshold (LT), after 1 and 3 months the CRT was repeated and the training walking mode was dynamically recounted according to the new LT level. For CG, the training walking mode was calculated based on the VO2peak values. All patients trained for 6 months. At the end of the training, diagnostic CRT was performed, and the activity of EGO was evaluated. Eleven patients with CHF and 3 healthy donors before the start of the training underwent a biopsy of the gastrocnemius muscle.Results. It was shown that the potential for muscle differentiation of satellite skeletal muscle precursor cells obtained from patients with CHF with a reduced ejection fraction (HFrEF) does not differ in vitro from the potential of satellite cells of healthy donors. After 6 months of training, the severity of CHF decreased to FC II in 75% of EG patients, and among CG patients — in 44%; the main indicators of the stages of compensatory mechanisms activation during physical exertion (VO2LT and VO2peak) in EG increased more than in the CG (10,8±0,4, 18,7±0,7 ml/min/kg and 9,5±0,8, 15,3±0,9 ml/min/kg, with p1<0,01, p2<0,05, p3<0,01, respectively). Conclusion. In vitro, the potential for muscle differentiation, regeneration and growth of satellite skeletal muscle precursor cells obtained from patients with HFrEF does not differ from the potential of satellite cells of healthy donors. Aerobic training in patients with III FC chronic heart failure calculated by definition of LT, relating to safety is not worse than the results calculated by the level of VO2peak. Aerobic training in patients with III FC chronic heart failure calculated by definition of LT, compared with the usual mode of training walking, significantly reduce the activity of ergoreflex, increase ET, reduce the severity of CHF. In patients with III FC CHF, training walking for more than 1,5 hours/day determined by the level of LT, contributes to the development of physiological reverse myocardial remodeling to a greater extent than aerobic training calculated by the conventional method.

Aim. To study psychic, cognitive status and life quality of petients underwentcoronary bypass grafting (CABG).Material and methods. Totally 81 patient with CHD studied (80% men, 20%women) with the age 56,3±1 y. o., underwent planned CABG. On 7–8th day afterCABG the 6-minute walk test (WT) was done and the Hospital anxiety-depressionscore used, Hamilton anxiety-depression score, Spielberger anxiety score and othermethods to assess asthenia and cognitive status (MMSE, MoCA). Life Quality (LQ)assessed with 10-points visual-analogue scale; coping behavioural strategiesstudied.Results. Values by WT were 415±130 m, LQ — 6±0,3 points. In 35% patients therewas lowering of cognitive functioning. In 20% there were affective disorders and thenegative correlation of WT with anxiety (r= –0,3; p<0,01), affective disorders with LQ(r= –0,53; p<0,05). Anxiety was comorbid to depression (r=0,91; p<0,05). Moderateand prominent asthenia registered in 36% and 18% of patients, asthenia was linkedwith affective (r=0,96; р<0,02) and cognitive (r=0,97; р<0,001) disorders. 46%patients used non-constructive and relatively constructive coping strategies.Conclusion. On 7–8th days after CABG in 35% patients there is lowering ofcognitive functioning and not less than 20% show signs of affective disorders, thatimpacts LQ of patients and tolerability of physical exertion. The anxiety anddepression revealed were associated not only with each other but with asthenisationof patients to. Cognitive disorders and emotional dyscomfort, experiencing bypatients, may affect adaptation leading to non-constructive coping strategies. Thefound specifics of psychic and cognitive status must be taken into account forelaboration of individualized patient-centered programs of rehabilitation afterCABG.

Aim. To study psychic, cognitive status and life quality of petients underwent coronary bypass grafting (CABG). Material and methods. Totally 81 patient with CHD studied (80% men, 20% women) with the age 56,3±1 y. o., underwent planned CABG. On 7–8th day after CABG the 6-minute walk test (WT) was done and the Hospital anxiety-depression score used, Hamilton anxiety-depression score, Spielberger anxiety score and other methods to assess asthenia and cognitive status (MMSE, MoCA). Life Quality (LQ) assessed with 10-points visual-analogue scale; coping behavioural strategies studied. Results. Values by WT were 415±130 m, LQ — 6±0,3 points. In 35% patients there was lowering of cognitive functioning. In 20% there were affective disorders and the negative correlation of WT with anxiety (r= –0,3; p<0,01), affective disorders with LQ (r= –0,53; p<0,05). Anxiety was comorbid to depression (r=0,91; p<0,05). Moderate and prominent asthenia registered in 36% and 18% of patients, asthenia was linked with affective (r=0,96; р<0,02) and cognitive (r=0,97; р<0,001) disorders. 46% patients used non-constructive and relatively constructive coping strategies. Conclusion. On 7–8th days after CABG in 35% patients there is lowering of cognitive functioning and not less than 20% show signs of affective disorders, that impacts LQ of patients and tolerability of physical exertion. The anxiety and depression revealed were associated not only with each other but with asthenisation of patients to. Cognitive disorders and emotional dyscomfort, experiencing by patients, may affect adaptation leading to non-constructive coping strategies. The found specifics of psychic and cognitive status must be taken into account for elaboration of individualized patient-centered programs of rehabilitation after CABG.

Цель. Оценить безопасность и эффективность велотренировок пациентов, перенесших коронарное шунтирование (КШ), на госпитальном этапе реабилитации.Материалы и методы. Обследованы 60 больных в возрасте 56,4±1,2 года (79% - мужчины). Исходно (на 8-9-й день после КШ) и перед выпиской (17-19-й день после КШ) всем больным выполняли тест с 6-минутной ходьбой (ТШХ), оценивали уровень тревоги и депрессии по Госпитальной шкале тревоги и депрессии, выраженность астении по Шкале астенического синдрома и качество жизни (КЖ) по 10-балльной визуальной аналоговой шкале. Всем больным проводилась стандартная программа стационарного этапа физической реабилитации, включающая занятия лечебной гимнастикой (ЛГ) и дозированную ходьбу. На 10-12-е сутки неосложненного течения послеоперационного периода 27 больным, изъявившим свое добровольное согласие, дополнительно были предложены тренировки на велотренажере (ВТ) с горизонтальной посадкой (группа ВТ). Остальные пациенты составили группу сравнения (группа ЛГ). Мощность тренирующей нагрузки устанавливалась в соответствии с результатами исходного ТШХ (при результате ТШХ≤300 м - 25 Вт, 300-400 м - 30 Вт, ≥400-500 м - 35 Вт) и в дальнейшем не менялась. Исходная длительность тренировки (6 мин), в случае ее хорошей переносимости, ежедневно увеличивалась на 2 мин. Количество ВТ составило в среднем 5,8 на 1 человека.Результаты. Исходные результаты ТШХ пациентов группы ВТ превышали таковые в группе ЛГ (438,2±13,5 м против 386,7±16,3 м соответственно, p =0,02). У всех больных исходно отсутствовали клинические признаки астении и аффективных расстройств, однако тревога и депрессия оказались взаимосвязаны (r=0,68, p