Volume 28, Issue 1 (3-2021)                   RJMS 2021, 28(1): 64-74 | Back to browse issues page

Ethics code: 1398.1167
Clinical trials code: IRCT20191125045496N1

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Urmia University, Urmia, Iran , a.tofighi@urmia.ac.ir
Abstract:   (8543 Views)
Background & Aims: Coronary heart disease is the most common type of cardiovascular disease (1) and a coronary artery bypass graft (CABG) is the first surgical procedure used to treat coronary heart disease (2).  (CABG). Powell et al (2017) reported that more than one third of patients (36%) had moderate to severe symptoms of depression based on Beck questionnaire (6). 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 (7). Cardiac troponin I is a regulatory protein that forms part of the contractile system of cardiac cells (8). The cardiac isoenzyme creatine kinase is responsible for the transfer of the phosphate group to creatine in heart cells (7). Clinical studies have shown that troponin I and creatine kinase increase after CABG surgery and return to baseline after a few days (9), there may be an increase in troponin I levels for several days in these patients. The primary increase in cardiac troponin I is associated with the release of cytosolic troponin I and its secondary increase is related to the release of troponin I from myofibrils that rehabilitate the heart. Long-term increase in troponin has been observed in patients with angina pectoris (8). Creatine kinase index is also used to diagnose the severity of heart disease, and since this isozyme is not significantly concentrated in extracellular tissues, it is considered as a relatively special cardiac index. It is possible to determine the severity of possible injuries as well as the appropriate treatment method by testing these indicators (7). Another method used to treat these patients is potent and selective serotonin reuptake inhibitors (16). Studies have illustrated that selective serotonin reuptake inhibitors (SSRI), such as sertraline can be used to treat tissue damage, inflammation, anxiety, and depression in heart patients because they are safe and well tolerated)17). Research has determined that SSRIs can be profitable for the cardiovascular system and also reduce the risk of cardiovascular disease (18). Andrew et al (2016) claimed that aerobic exercise with a dose of 50-200 mg of sertraline per day decreased the level of depression and increased the quality of life in cardiovascular patients (19).
Methods: The present study is a randemized double-blind clinical trial that was performed by availability sampling method in the cardiopulmonary rehabilitation ward of Fatemeh Zahra Heart Hospital in Sari. The permission was obtained from the hospital management. The necessary ethical 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. Ultimately, patients were randomly divided into 4 groups: 1- aerobic exercise+sertraline, (n = 9) 2- aerobic exercise+placebo (n = 8), 3- sertraline (n = 8) 4- control (placebo) (n = 8). The studied variables including age, physical characteristics (height, weight, body mass index), psychological characteristics (anxiety and depression) and quality of life were measured before and after the exercise rehabilitation program. In addition to routine care, intervention groups (aerobic exercise and aerobic exercise with medication) participated in an 8-week aerobic program. The aerobic exercise group with the drug and the drug group took sertraline at a minimum dose of 25 mg and a maximum dose of 50 mg once daily (in the evening) based on the therapist's prescription for 2 months (19). The aerobic and control training group used a placebo with the same dose and duration, as well as the same shape and color as the original medicine made by Hakim Daroo Company. In this study, Kolmogorov-Smirnov test was used to determine the normal distribution of data, and descriptive statistics were used to arrange and describe the data. Analysis of Covariance (ANOVA), correlated t-test and Bonferroni post hoc test were also used in inferential statistics. It should be noted that statistical tests were analyzed using SPSS software version 22 at a significance level of P <0.05.
Results: The results of statistical analysis of the data showed that there is no significant difference between the four groups including exercise + placebo, exercise + drug, drug and placebo in the pre-test values. Based on Table 2, the result of analysis of covariance (ANOVA) illustrated that there is a significant diference between the groups in the levels of CK-MB and quality of life in post-test values (p <0.05 between groups). The results of correlated t-test demonstrated that there is a significant difference between the levels of troponin I and CK-MB in the exercise + drug groups, and also the quality of life index in the exercise + placebo, exercise + drug, drug and placebo groups was before the intervention (p <0.05 within the group).The results of post hoc test in Table 3 showed that there is a significant difference between the group of  exercise + drug  and placebo in the level of  CK-MB and there is also a significant difference between exercise + placebo, exercise + drug, drug and placebo groups in quality of life index (p <0.05).
Conclusion: This study was aimed to evaluate the interaction effect of cardiac rehabilitation and sertraline on troponin I, creatine kinase and quality of life in CABG patients undergoing chronic depression. The results illustrated that aerobic exercise with sertraline decreased troponin I, CK-MB and increased quality of life during 8 weeks. The findings demonstrated that cardiac rehabilitation with sertraline was able to reduce cardiac tissue damage and improve quality of life CABG patients undergoing chronic depression. Therefore, moderate intensity aerobic exercise with sertraline can be used as an effective factor to improve the indicators of heart tissue damage and quality of life in patients after coronary artery bypass graft surgery.
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Type of Study: Research | Subject: Clinical Psychiatry

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