Effectsof Early Cardiac Rehabilitationon Short-term Ventricular Remodeling、Exercise Enduranceand Peripheral Blood Monocyte NLRP3 In Patientswith Acute Myocardial Infarctionafter Percutaneous Coronary Iterventionn

Objective:To observe the effect of early cardiac rehabilitation on ventricular remodeling and exercise endurance in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI);To observe the changes of NLRP3 level in peripheral blood monocytes at different time after acute myocardial infarction,and to explore the effect of early cardiac rehabilitation on NLRP3 level in peripheral blood monocytes.Methods:80 patients with acute myocardial infarction admitted to the Department of Cardiology of the second affiliated Hospital of Dalian Medical University from October 2018 to November 2019 were selected.Patients with acute ST segment elevation myocardial infarction(STEMI)were treated with PCI,patients with acute non-ST segment elevation myocardial infarction(NSTEMI)were treated with PCI within 2 days of admission.All patients were given standard treatment(double antiplatelet therapy,heparin and statins,BBs and ACEI according to heart rate and blood pressure).According to whether they were willing to participate in early cardiac rehabilitation(CR),they were divided into standard treatment group(SDT)(n=40)and standard treatment plus early CR group(SDT+CR)(n=40).The SDT+CR began to recover from the second day of admission according to the process of(expert consensus on exercise rehabilitation after percutaneous coronary intervention》[1]and lasted for 12 weeks.CRP,BNP,blood lipids,liver biochemistry,renal function,cTnI,blood routine,fasting blood glucose and glycosylated hemoglobin were detected in all selected AMI patients on the morning of the second day of admission.At 24-36 hours(T0),1st(T1),4th(T2)and 12th(T3)week after admission,BNP level was reexamined,the left ventricular end-diastolic diameter(LVEDd)and left ventricular ejection fraction(LVEF)were recorded by echocardiography at 1 week(T1),4 weeks(T2)and 12 weeks(T3)after onset.The quality of life scale(SF-12)and generalized anxiety scale(GAD-7)were performed at the 1 st(T1)and 12th(T3)week.At the 12th week(T3),cardiopulmonary exercise test recorded peak oxygen uptake per kilogram(peakV02/kg),ocygen uptake in kilogram at anaerobic th resh old(VO2/kg@AT),metabolic equivalent on anaerobic threshold(Mets@AT).The effects of early cardiac rehabilitation on short-term ventricular remodeling,exercise endurance and quality of life were observed.Peripheral venous blood was drawn from all patients at 24-36 hours(T0),1st week(T1),4th weeks(T2)and 12th weeks(T3),after the onset of chest pain,the NLRP3 level of peripheral blood monocytes was detected by flow cytometry.To observe the changes of NLRP3 level in peripheral blood mononuclear cells at different time after acute myocardial infarction,and to explore the effect of early cardiac rehabilitation on peripheral blood monocyte NLRP3 level.All the data were analyzed by SPSS 25.0 statistical software.Results:1.There was no significant difference in the level of peripheral blood BNP between the SDT+CR and the SDT on T0 and T1 after hospitalization(P>0.05),the level of BNP in the two groups decreased gradually in T2 and T3,the level of BNP in the SDT+CR was significantly lower than that in the SDT at T2(84.75(48.88-183.10)ng/ml vs 121.00(70.65-373.55)ng/ml,P<0.05)and T3(36.80(10.85-72.03)ng/ml vs 50.00(28.95-234.65)ng/ml,P<0.05).There was no significant difference in LVEF between the two groups at T1 and T2(P>0.05),at T3,the LVEF in the SDT+CR was significantly higher than that in the SDT(61.11±3.52%vs 57.94±4.60%,P<0.05).In T1,there was no significant difference in the scores of SF-12 and GAD-7 between the SDT+CR and the SDT(P>0.05).At T3,the score of SF-12 in the SDT+CR was significantly higher than that in the SDT(78.44±15.64score vs 70.35±13.12score,P<0.05),the score of GAD-7 in the SDT+CR was significantly lower than that in the SDT(0.00(0.00-2.00)score vs 2.50(0.00-8.00)score,P<0.05).At T3,the peakVO2/kg(8.66±2.78L/kg.min vs 6.67±1.59L/kg.min,P<0.05),V0 2/kg@AT(7.20±2.42ml/kg.min vs 5.62±1.60ml/kg.min,P<0.05)and Mets@AT(2.02±0.66 vs 1.61±0.44,P<0.05)in the cardiopulmonary exercise test in the SDT+CR were significantly higher than those in the SDT.2.In the SDT+CR and the SDT,the level of peripheral blood monocyte NLRP3 was the highest at T0,there was no significant difference between the two groups(P>0.05).The NLRP3 level of peripheral blood monocytes in the two groups decreased gradually at T1,T2 and T3.At T1,there was no significant difference in the NLRP3 level of peripheral blood monocytes between the rehabilitation group and the control group(P>0.05).At T2(704.55±173.13 vs 777.20±62.98,P<0.05)and T3(642.97±147.00 vs 724.70±148.43,P<0.05)week,the NLRP3 level of peripheral blood monocytes in the rehabilitation group was significantly lower than that in the control group.Conclusion:1.Early cardiac rehabilitation can significantly improve cardiac function,exercise tolerance and quality of life in patients with AMI.2.The NLRP3 level of peripheral blood monocytes in the SDT+CR was significantly lower than that in the SDT,suggesting that early cardiac rehabilitation can improve the inflammatory response in patients with AMI,early cardiac rehabilitation should be actively used in patients with myocardial infarction.