Volume 28, Issue 1 (3-2021)                   RJMS 2021, 28(1): 0-0 | Back to browse issues page

Research code: -
Ethics code: 1398.1167
Clinical trials code: IRCT20191125045496N1

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Behzad Khameslo M, Tofighi A, Tolouei Azar J, Hosseini S H, Madani Z. Interaction Effect Of Cardiac Rehabilitation And Sertraline On Troponin I, Creatine Kinase And Quality Of Life In CABG Patients With Chronic Depression. RJMS. 2021; 28 (1)
URL: http://rjms.iums.ac.ir/article-1-6443-en.html
Associate Professor, Department of Sport Physiology, Faculty of Physical Education and Sport Sciences, Urmia University, Urmia, Iran , a.tofighi@urmia.ac.ir
Abstract:   (132 Views)
Aims: Coronary artery disease is the most common disease among cardiovascular diseases and coronary artery bypass graft surgery (CABG) is the first treatment of choice for coronary artery disease. Depression and tissue damage are the most common symptoms. Which occurs extensively afterwards. Various indicators have been used to evaluate heart disease.In recent years, new indicators called cardiac troponin I and cardiac creatine kinase isoenzyme (CK-MB) have been used to study myocardial cell damage.Cardiac tropropin I is a regulatory protein that forms part of the contractile system of cardiac cells. The cardiac isoenzyme creatine kinase is responsible for transporting the phosphate group to creatine in cardiac cells. Clinical studies have shown that troponin I and creatine after CABG action increases and returns to baseline after a few days. There may be an increase in troponin I levels for several days in these patients.One of the methods is exercise therapy. Cardiac rehabilitation can improve the functional capacity and quality of life of heart patients by increasing a personchr(chr(chr(chr('39')39chr('39'))39chr(chr('39')39chr('39')))39chr(chr(chr('39')39chr('39'))39chr(chr('39')39chr('39'))))s independence for normal daily activities. Moderate-intensity exercise is one of the things that can be useful in preventing coronary heart disease and by the World Health Organization. It has been proven that increasing physical activity improves mental and physical condition and reduces mortality.In the study of Si Chou et al. (2108) showed that patients who underwent cardiac rehabilitation intervention compared to the control group reported a decrease in heart tissue damage and increased quality of life in these people. Litama et al. (2008) in the study Showed that troponin levels increased significantly after the competition in the triathlon.Another method used to treat these patients is the use of potent and selective serotonin reuptake inhibitors. Studies have shown that selective serotonin reuptake inhibitors (SSRIs) such as sertraline are used to treat tissue damage, inflammation, and Anxiety and Depression can be used in patients with heart disease because it is a well-tolerated and safe drug. Research has shown that SSRIs can be beneficial for the cardiovascular system and also reduce the risk of cardiovascular disease.Andrew et al. (2016) reported in their study that aerobic exercise with a dose of 50-200 mg of sertraline per day reduced the level of depression and increased the quality of life in cardiovascular patients. Due to the importance of the consequences of CABG surgery, Because tissue damage and depression affect mental health and quality of life, as well as the role of exercise and sertraline, its relationship with mental health, conducting research in this field is important.Therefore, due to limited trial studies, inconsistencies and ambiguities in the effectiveness of interventions, limited research with poor methodology on the preference of each of these methods with appropriate comparison in this research community with the aim of the interactive effect of cardiac rehabilitation and troponin I, Creatine kinase and quality of life are performed in CABG patients with chronic depression.
Materials & Methods: The present study is a double-blind clinical trial that was performed by available sampling method in Fatemeh Zahra Sari Cardiovascular Hospital, Cardiac and Pulmonary Rehabilitation Department. Prior to the study, permission was obtained from the hospital management. Necessary moral license was received from the Medical Ethics Committee of Mazandaran University of Medical Sciences (ethics code 1398.1167) and was registered in the clinical trial system with the code IRCT20191125045496N1.The study population consisted of patients who underwent coronary artery bypass surgery and went to Fatemeh Zahra Educational and Medical Center in Sari for post-operative clinical examinations. Finally, patients were randomly divided into 4 groups: 1- aerobic exercise with sertraline (9 patients) 2- aerobic exercise with placebo (8 patients) 3- sertraline (8 patients) 4- control (placebo) (8 patients) N) were divided.Before and after the exercise rehabilitation program, the studied variables such as age, physical characteristics (height, weight, body mass index), psychological characteristics (anxiety and depression) and quality of life were measured. Intervention groups (aerobic exercise) And aerobic exercise with medication) In addition to routine care, participated in an 8-week aerobic program.Aerobic exercise for eight weeks (three sessions per week) including 6 to 14 intensity training (RPE) on the Borg pressure perception scale, equivalent to (60 to 75% of the maximum heart rate) for 10 to 20 minutes on a treadmill, then exercise with Manual ergometer with an intensity of 30 to 50 watts for 8 to 10 minutes and then exercise on a stationary bike with an intensity of 30 to 50 watts for 8 to 10 minutes, under the supervision of sports medicine, exercise physiology and nurse.The aerobic exercise group with medication and the drug group used sertraline at a dose of at least 25 mg and at most 50 mg once daily (in the evening) according to the doctorchr(chr(chr(chr('39')39chr('39'))39chr(chr('39')39chr('39')))39chr(chr(chr('39')39chr('39'))39chr(chr('39')39chr('39'))))s instructions for 2 months. They used the same color as the main drug made by Hakim Daroo Company with the same dose and duration. In this study, the short form of Quality of Life Questionnaire (SF-36), which was standardized by Montazeri et al. And translated into Persian, was used. To measure serum levels of troponin I and CK-MB, serum samples at the beginning of the study and later. Fasting exercise was taken from 8 weeks. Troponin I was performed bilaterally by immunoluminometric method with LIAISON troponin I kit made in Italy.CK-MB measurement by ELISA method using CK-MB kit (method  Immunological) was performed.In this study, Kolmogorov-Smirnov test was used to determine the normal distribution of data and descriptive statistics were used to sort and describe the data. Also in the inferential statistics section, analysis of covariance (ANKOVA), correlated t-test and Beferroni post hoc test were used.It is worth mentioning that statistical tests were analyzed using SPSS software version 22 at a significance level of P <0.05.
Findings: The results of correlated t-test showed a significant decrease in the exercise + drug group in troponin I and CK-MB compared to the other groups (level of p = 0.0027; p = 0.000) and also changes within the group in quality of life index It was significant compared to placebo in all three groups (p = 0.002; p = 0.001; p = 0.001). The results of analysis of covariance showed that between the groups in CK-MB and quality of life were statistically Was significant (p = 0.009; p = 0.002).
Conclusion: The findings of our study showed that cardiac rehabilitation combined with sertraline drug could reduce cardiac tissue damage and improve quality of life in patients with coronary artery bypass graft with chronic depression. Moderate use of sertraline was used as an effective factor in improving cardiovascular injury indices and quality of life in patients after coronary artery bypass graft surgery.
     
Type of Study: Research | Subject: Clinical Psychiatry

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