ORIGINAL ARTICLE

Effect of preoperative inspiratory muscle training on right ventricular systolic function in patients after heart valve replacement surgery

Hari Hendriarti Satoto , Aditya Paramitha, Sri Hastuti Barata, Sugiri Sugiri, Suhartono Suhartono, Sri Wahyudati, Sefri Noventi Sofia

Hari Hendriarti Satoto
Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Diponegoro- Dr. Kariadi Gen-eral Hospital, Semarang, Indonesia. Email: [email protected]

Aditya Paramitha
Physical Medicine and Rehabilitation Department, Faculty of Medicine, Universitas Diponegoro- Dr. Kariadi General Hospital, Semarang, Indonesia

Sri Hastuti Barata
Physical Medicine and Rehabilitation Department, Faculty of Medicine, Universitas Diponegoro- Dr. Kariadi General Hospital, Semarang, Indonesia

Sugiri Sugiri
Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Diponegoro- Dr. Kariadi Gen-eral Hospital, Semarang, Indonesia

Suhartono Suhartono
Public Health Department, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Sri Wahyudati
Physical Medicine and Rehabilitation Department, Faculty of Medicine, Universitas Diponegoro- Dr. Kariadi General Hospital, Semarang, Indonesia

Sefri Noventi Sofia
Cardiology and Vascular Medicine Department, Faculty of Medicine, Universitas Diponegoro- Dr. Kariadi Gen-eral Hospital, Semarang, Indonesia
Online First: April 30, 2021 | Cite this Article
Satoto, H., Paramitha, A., Barata, S., Sugiri, S., Suhartono, S., Wahyudati, S., Sofia, S. 2021. Effect of preoperative inspiratory muscle training on right ventricular systolic function in patients after heart valve replacement surgery. Bali Medical Journal 10(1): 340-346. DOI:10.15562/bmj.v10i1.2182


Background: The reduction of right ventricular function after heart valve surgery was associated with mortality and morbidity after cardiac surgery, prolonged ICU length of stay, and higher hospital cost. Inspiratory muscle training can be considered for improving right ventricular systolic function by optimizing afterload dan cardiac contractility. The study aims to determine the effect of inspiratory muscle training on right ventricular systolic function in patients after heart valve surgery.

Methods: Patients undergoing heart valve surgery were randomized into a conventional preoperative rehabilitation group and conventional preoperative rehabilitation added high-intensity inspiratory muscle training at least 14 days before surgery. Echocardiography examination was performed before rehabilitation and after cardiac surgery.

Results: There were 24 subjects consist of 12 control group and 12 intervention group. By using independent t-test or Mann Whitney test, we found significant differences on right ventricular function between intervention and control group, by using RV free wall strain (17.7 + 3.0% and 14.4 + 4.0%; p=0.033), RV FAC (43.2 + 4.9% and 35.1 + 8.8%; p=0.006), and TAPSE (12.7 + 3.4 mm and 9.9 + 2.7 mm; p=0.039). ICU length of stay in the intervention group was significantly shorter than the control group (3.2 + 0.8 and 4.2 + 1.3 days; p=0.044).

Conclusion: Patients underwent conventional preoperative rehabilitation added inspiratory muscle training had better right ventricular systolic function than patients in control group.

References

Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2017;38(36):2739–2791, https://doi.org/10.1093/eurheartj/ehx391

Osorio RC, Solano de Freitas Souza F, Novaes de Andrade M, Câmara de Freitas B, Durães AR. Valvular Heart Diseases - Epidemiology and New Treatment Modalities. Interv Cardiol J. 2016;2:1–11.

Bootsma IT, de Lange F, Koopmans M, Haenen J, Boonstra PW, Symersky T, et al. Right Ventricular Function After Cardiac Surgery Is a Strong Independent Predictor for Long-Term Mortality. J Cardiothorac Vasc Anesth. 2017;31:1656–1662.

Mandoli GE, Cameli M, Novo G, Agricola E, Righini FM, Santoro C, D'Ascenzi F, An-cona F, Sorrentino R, D'Andrea A, Galderisi M, Mondillo S; Working Group of Echo-cardiography of the Italian Society of Cardiology. Right ventricular function after car-diac surgery: the diagnostic and prognostic role of echocardiography. Heart Fail Rev. 2019;24(5):625-635. doi: 10.1007/s10741-019-09785-2.

Haddad F, Denault AY, Couture P, Cartier R. Right Ventricular Myocardial Performance Index Predicts Perioperative Mortality or Circulatory Failure in High-Risk Valvular Surgery. J Am Soc Echocardiogr. 2007;20:1065–1072.

Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth Analg. 2009;108(2):422-33. doi: 10.1213/ane.0b013e31818d8b92. PMID: 19151265.

Vlahakes GJ. Right Ventricular Failure After Cardiac Surgery. Cardiol Clin. 2012;30:283–289.

Marmelo F, Rocha V, Moreira-Gonçalves D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical inter-vention: Systematic review and meta-analysis. Eur J Prev Cardiol. 2018;25(4):404-417. doi: 10.1177/2047487317752373.

Kelley R, Ferreira L. Diaphragm abnormalities in heart failure and aging: mechanisms and integration of cardiovascular and respiratory pathophysiology. Hear Fail Rev. 2017;20:48–55.

Dall’ago P, Chiappa G, Guths H, Stein R, Ribeiro J. Inspiratory Muscle Training in Patients With Heart Failure and Inspiratory Muscle Weakness. J Am Coll Cardiol. 2006;47:757–763.

Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G et al. Inspiratory muscle training in heart disease and heart failure: A review of the literature with a focus on method of training and outcomes. Expert Rev Cardiovasc Ther. 2013;11:161–177.

Letavernier E, Zafrani L. The role of calpains in myocardial remodeling and heart failure. Cardiovasc Res. 2012;1:38–45.

Wang Y, Chen B, Huang CK, Guo A, Wu J, Zhang X, Chen R, Chen C, Kutschke W, Weiss RM, Boudreau RL, Margulies KB, Hong J, Song LS. Targeting Calpain for Heart Failure Therapy: Implications From Multiple Murine Models. JACC Basic Transl Sci. 2018;3(4):503-517. doi: 10.1016/j.jacbts.2018.05.004.

Hulzebos EHJ, Helders PJM, Favie NJ, Bie RA De, Brutel de la Rivière A, Van Meeteren NLU. Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk. JAMA J Am Med Assoc. 2006;296:1851–1857.

Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspir-atory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015;(10):CD010356. doi: 10.1002/14651858.CD010356.pub2.

Parati G, Malfatto G, Boarin S, Branzi G, Caldara G, Giglio A, Bilo G, Ongaro G, Alter A, Gavish B, Mancia G. Device-guided paced breathing in the home setting: effects on exercise capacity, pulmonary and ventricular function in patients with chronic heart failure: a pilot study. Circ Heart Fail. 2008;1(3):178-83. doi: 10.1161/CIRCHEARTFAILURE.108.772640.

Todd JS, Shurley JP, Todd TC. Thomas L. DeLorme and the science of progressive re-sistance exercise. J Strength Cond Res. 2012;26(11):2913-23. doi: 10.1519/JSC.0b013e31825adcb4.

Marco E, Ramírez-Sarmiento AL, Coloma A, Sartor M, Comin-Colet J, Vila J, Enjuanes C, Bruguera J, Escalada F, Gea J, Orozco-Levi M. High-intensity vs. sham in-spiratory muscle training in patients with chronic heart failure: a prospective random-ized trial. Eur J Heart Fail. 2013;15(8):892-901. doi: 10.1093/eurjhf/hft035.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Sol-omon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography en-dorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713; quiz 786-8. doi: 10.1016/j.echo.2010.05.010.

Tamborini G, Muratori M, Brusoni D, Celeste F, Maffessanti F, Caiani EG, Alamanni F, Pepi M. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. Eur J Echocardiogr. 2009;10(5):630-4. doi: 10.1093/ejechocard/jep015.

Magne J, Pibarot P, Sengupta PP, Donal E, Rosenhek R, Lancellotti P. Pulmonary hy-pertension in valvular disease: a comprehensive review on pathophysiology to therapy from the HAVEC Group. JACC Cardiovasc Imaging. 2015;8(1):83-99. doi: 10.1016/j.jcmg.2014.12.003.

Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Ha-gendorff A, Monin JL, Badano L, Zamorano JL; European Association of Echocardiog-raphy. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve dis-ease). Eur J Echocardiogr. 2010;11(4):307-32. doi: 10.1093/ejechocard/jeq031.

Singh A, Huang X, Dai L, Wyler D, Alfirevic A, Blackstone EH, Pettersson GB, Dun-can AE. Right ventricular function is reduced during cardiac surgery independent of procedural characteristics, reoperative status, or pericardiotomy. J Thorac Cardiovasc Surg. 2020;159(4):1430-1438.e4. doi: 10.1016/j.jtcvs.2019.04.035.

Jadhav T, Kareem H, Nayak K, Pai U, Devasia TOM, Padmakumar R. A study of right ventricular function in pre- and post-valvular surgeries. Interv Med Appl Sci 2018; 10: 137–144.

Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardio-vascular disease, part I: Anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008;117(11):1436-48. doi: 10.1161/CIRCULATIONAHA.107.653576.

Itagaki S, Hosseinian L, Varghese R. Right Ventricular Failure After Cardiac Surgery: Management Strategies. Semin Thorac Cardiovasc Surg. 2012;24:188–194.

Laoutaris ID, Dritsas A, Brown MD, Manginas A, Kallistratos MS, Degiannis D, et al. Immune response to inspiratory muscle training in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2007;14:679–685.

Donauer M, Schneider J, Jander N, Beyersdorf F, Keyl C. Perioperative Changes of Right Ventricular Function in Cardiac Surgical Patients Assessed by Myocardial De-formation Analysis and 3-Dimensional Echocardiography. J Cardiothorac Vasc Anesth. 2020;34(3):708-718. doi: 10.1053/j.jvca.2019.08.026.

Felix S, Paula A, Siciliano V, Herman L, Belém J, Schwartz F, et al. Echocardiographic Assessment of Right Ventricular Function by Two-Dimensional Strain In Patients with Left-Sided Valvular Heart Disease : Comparison with Three- Dimensional Echocardiography. Int J Cardiovasc Sci. 2018;31:630–642.

Shukla M, Park J-H, Thomas JD, Delgado V, Bax JJ, Kane GC, et al. Prognostic Value of Right Ventricular Strain Using Speckle-Tracking Echocardiography in Pulmonary Hypertension: A Systematic Review and Meta-Analysis. Can J Cardiol. 2018;34:1069–1078.


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