Bulletin of Rehabilitation MedicineBulletin of Rehabilitation Medicine2078-19622713-2625National Medical Research Center for Rehabilitation and Balneology59573010.38025/2078-1962-2023-22-2-52-65Research ArticleECG telemonitoring of Cardiac Risks in Medical Rehabilitation of Stroke Patients: Controlled Study in Parallel GroupsPogonchenkovaIrena V.<p>Dr. Sci. (Med.), Associate Professor, Director</p>pogonchenkovaiv@zdrav.mos.ruhttps://orcid.org/0000-0001-5123-5991KostenkoElena V.<p>Dr. Sci. (Med.), Professor, Chief Scientist, Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department, Professor of the Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University; neurologist, Chief Scientific Officer Researcher of the Department of Medical Rehabilitation</p>ekostenko58@mail.ruhttps://orcid.org/0000-0003-0902-348XPetrovaLiudmila V.<p>Ph. D. (Med.), senior scientific member of Department of Medical Rehabilitation, Neurologist, the Head of the Rehabilitation Department</p>ludmila.v.petrova@yandex.ruhttps://orcid.org/0000-0003-0353-553XNeprintsevaNatalia V.<p>Ph. D. (Med.), therapist</p>nataliya.nepr@gmail.comhttps://orcid.org/0000-0003-4509-5552Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare DepartmentPirogov Russian National Research Medical University2409202322252652409202324092023Copyright © 2023, Pogonchenkova I.V., Kostenko E.V., Petrova L.V., Neprintseva N.V.2023<p><strong>INTRODUCTION.</strong> Safety and the personal dosing of physical activity are the main aspects of medical rehabilitation in stroke patients.</p> <p><strong>AIM. </strong>To study the possibilities of assessment and correction of cardiac risks by ECG telemonitoring during complex medical rehabilitation of patients in early and late recovery period of ischemic cerebral stroke (IS).</p> <p><strong>MATERIALS AND METHODS.</strong> The study included 60 patients in the early and 60 patients in the late recovery period of IS aged 45 to 75 years. During each procedure of complex medical rehabilitation with multimodal impact on impaired motor functions, the ECG parameters of patients were monitored using a portable telecardiocomplex (ECG Dongle cardioflash). Real-time ECG analysis allowed individual correction of the rehabilitation load.</p> <p><strong>RESULTS AND DISCUSSION. </strong>ECG changes were analyzed in subgroups of patients taking into account the pathogenetic subtype of IS according to TOAST. The high comorbidity of patients with IS according to the cardiac profile was confirmed (arterial hypertension 64.1 %, dislipidemia 68.3 %, obesity 41.6 %, ischemic heart disease 15 %). There were clinically significant ECG changes: ventricular extrasystole in RVP in 11.7 % of cases, PVP in 8.3 %; atrial fibrillation in RVP in 16.7 %, in PVP in 10 % of patients, conduction abnormalities in 15 % and 11.7 % cases, respectively. Most ECG abnormalities were clinically asymptomatic. Most of the patients had marked abnormalities of cardiac activity regulation, also clinically asymptomatic. Individual correction of the motor rehabilitation program in patients with clinically significant ECG changes allowed to fully complete the medical rehabilitation course in patients with IS.</p> <p><strong>CONCLUSION. </strong>The use of remote TMT in assessing cardiac safety in patients after IS provides a personalized approach and allows for a reliable assessment of cardiac risks, including in comorbid patients, which expands the prospects and possibilities of their rehabilitation.</p>cardiac safetyischemic stroketelemedicinemedical rehabilitationcomorbidityelectrocardiographycardiac arrhythmiasкардиобезопасностьишемический инсульттелемедицинамедицинская реабилитациякоморбидностьэлектрокардиографиянарушения ритма сердца1.Басенцова Н. Ю., Шишкин А. Н., Тибекина Л. М. Цереброкардиальный синдром и его особенности у пациентов с острым нарушением мозгового кровообращения. Вестник Санкт-Петербургского Университета. 2017; 12(1): 31–47. https://doi.org/10.21638/11701/spbu11.2017.103 [Basentsova N.Yu., Shishkin A. N., Tibekina L. M. Cerebrocardial syndrome and its features in patients with acute cerebrovascular accident. Vestnik SРbSU. Medicine. 2017; 12(1): 31–47. https://doi.org/10.21638/11701/spbu11.2017.103 (In Russ.).]2.Акжигитов Р. Г., Алекян Б. Г., Алферова В. В., Белкин А. А., Беляева И. А., Бойцов С. А., Вознюк И. А., Виноградов О. И., Герасименко М. Ю., Гераскина Л. А., Гехт А. Б., Гусев Е. И. Клинические рекомендации. Ишемический инсульт и транзиторная ишемическая атака у взрослых. Доступно на: https://www.neurology.ru/obrazovanie/lektsii-master-klassy-i-drugie-nauchno-prakticheskie-i-obrazovatelnye-meropriyatiya/klinicheskie-rekomendacii-ishemicheskiy-insult-i-tranzitornaya-ishemicheskaya-ataka-u-vzroslyh.html?ysclid=l9ruyfs1w2905659550 [Akzhigitov R. G., Alekyan B. G., Alferova V. V., Belkin A. A., Belyaeva I. A., Boitsov S. A., Voznyuk I. A., Vinogradov O. I., Gerasimenko M.Yu., Geraskina L. A., Geht A. B., Gusev E. I. Clinical recommendations. Ischemic stroke and transient ischemic attack in adults. Available at: https://www.neurology.ru/obrazovanie/lektsii-master-klassy-i-drugie-nauchno-prakticheskie-i-obrazovatelnye-meropriyatiya/klinicheskie-rekomendacii-ishemicheskiy-insult-i-tranzitornaya-ishemicheskaya-ataka-u-vzroslyh.html?ysclid=l9ruyfs1w2905659550 (In Russ.).]3.Winstein C. J., Stein J., Arena R. et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2016; 47(6): e98-e169. https://doi.org/10.1161/STR.0000000000000098.4.Cristian A., Green J. Patient safety and quality improvement in rehabilitation medicine. Physical Medicine and Rehabilitation Clinics of North America. 2012; 23(2): 221–230. https://doi.org/10.1016/j.pmr.2012.02.001.5.Сидякина И. В., Воронова М. В. Индивидуализированный подход к реабилитации пациентов с центральной дисфагией. Физиотерапия, бальнеология и реабилитация. 2016; 15(3): 137–141. https://doi.org/10.18821/16813456-2016-15-3-137-141 [Sidyakina I. V.,Voronova M. V. Individualized approach to rehabilitation of patients with central dysphagia. Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2016; 15(3): 137–141. https://doi.org/10.18821/16813456-2016-15-3-137-141 (In Russ.).]6.Гусев, Е.И., Коновалова А. Н., Скворцова В. И., Гехт А. Б. Неврология: Национальное руководство. М.: ГЭОТАР-Медиа. 2018; (1): 880 с. [Gusev E. I., Konovalova A. N., Skvorczova V. I., Gext A. B. Nevrologiya: Nacional`noe rukovodstvo. Moscow. «GE`OTAR-Media». 2018;(1): 880 p. (In Russ.).]7.Béjot Y., Daubail B., Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Revue Neurologique. 2016; 172(1): 59–68. https://doi.org/10.1016/j.neurol.2015.07.013.8.O’Connor A.M., Bennett C., Stacey D. et al. Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis. Medical Decision Making. 2007; 27(5): 554–574. https://doi.org/10.1177/0272989X07307319.9.Смышляев А. В., Мельников Ю. Ю., Шахабов И. В. Телемедицинские технологии как инструмент повышения доступности медицинской помощи для населения на современном этапе: ключевые проблемы и перспективы развития. Главврач. 2020; (5): 44–54. https://doi.org/10.33920/med-03-2005-05 [Smyshlyaev A. V., Melnikov Yu.Yu., Shahabov I. V. Telemedicine technologies as a tool to increase the availability of medical care for the population at the present stage: key problems and development prospects. Chief Medical Officer. 2020; (5): 44–54. https://doi.org/10.33920/med-03-2005-05 (In Russ.).]10.Карпов О. Э., Свешников А. В., Воробьев А. С. Новые методы мониторирования жизненно важных функций организма в эпоху телемедицины. Менеджер здравоохранения. 2016; (8): 54–66. [Karpov O. E., Sveshnikov A. V., Vorob`ev A. S. New methods of monitoring vital body functions in the era of telemedicine. Menedzher zdravooxraneniya. 2016; (8): 54–66 (In Russ.).]11.Thamman R., Janardhanan R. Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation. Reviews in Cardiovascular Medicine. 2020; 21(4): 497–500. https://doi.org/10.31083/j.rcm.2020.04.201.12.Piotrowicz E., Zieliński T., Bodalski R. et al. Home-based telemonitored Nordic walking training is well accepted, safe, effective and has high adherence among heart failure patients, including those with cardiovascular implantable electronic devices: a randomised controlled study. European Journal of Preventive Cardiology. 2015; 22(11): 1368–1377. https://doi.org/10.1177/2047487314551537.13.Владзимирский А. В., Лебедев Г. С. Телемедицина. М., 2018: 576 с. [Vladzimirsky A. V., Lebedev G. S. Telemedicine. Moscow. 2018: 576 p. (In Russ.).]14.Вейна А. М. Вегетативные расстройства: клиника, диагностика, лечение. М., 2003: 752 с. [Vane A. M. Vegetative disorders: clinic, diagnosis, treatment. Moscow. 2003: 752 p. (In Russ.).]15.Лемешко В. А., Тепцова Т. С. Телемедицина: здравоохранение делает шаг в будущее. Медицинские технологии. Оценка и выбор. 2017; 4(30): 30–38. [Lemeshko V. A., Teptsova T. S. Telemedicine: a Step to the Future of Health Care. Medical Technologies. Assessment and Choice. 2017; 4(30): 30–38 (In Russ.).]16.Толкачёва И. А. Теле-ЭКГ: опыт применения радиомониторного контроля ЭКГ в условиях многопрофильного стационара. Доктор.Ру. 2012; 10(78): 29–35. [Tolkacheva I. A. Tele-ECG: the experience of using radio monitoring of ECG in a multidisciplinary hospital. Doctor.Ru. 2012; 10(78): 29–35 (In Russ.).]17.Linder S. M., Rosenfeldt R. C., Bay S. M., Sahu K., Wolf S. L. Improving Quality of Life and Depression After Stroke Through Telerehabilitation. The American Journal of Occupational Therapy. 2015; 69(2): 6902290020p1–10. https://doi.org/10.5014/ajot.2015.014498.18.Барановская Е. Н., Бронников В. А., Буйлова Т. В., Даминов В. Д., Кизеев М. В., Конева Е. С., Лядов К. В., Тимашкова Г. В., Чаплыгина Ю. А., Шахнович В. А. Дистанционно контролируемая реабилитация (комплексная медицинская реабилитация с применением телемедицинской технологии) для пациентов со спастическим гемипарезом после перенесенного острого нарушения мозгового кровообращения (ОНМК) или черепно-мозговой травмы (ЧМТ). Клинические рекомендации. М., 2019: 66 с. [Baranovskaya E. N., Bronnikov V. A., Buylova T. V., Daminov V. D., Kizeev M. V., Koneva E. S., Lyadov K. V., Timashkova G. V., Chaplygina Yu.A., Shakhnovich V. A. Remote-controlled rehabilitation (complex medical rehabilitation with the use of telemedicine technology) for patients with spastic hemiparesis after acute cerebrovascular accident or traumatic brain injury (TBI). Clinical recommendations. Moscow. 2019; 66 p. (In Russ.).]19.Снопков П. С., Лядов К. В., Шаповаленко Т. В., Сидякина И. В. Дистанционная реабилитация: истоки, состояние, перспективы. Физиотерапия, бальнеология и реабилитация. 2016; 15(3): 141–145. https://doi.org/10.18821/16813456-2016-15-3-141-145 [Snopkov P. S., Lyadov K. V., Shapovalenko T. V., Sidyakina I. V. Distant rehabilitation: the sources, current state-of-the-art, and further prospects. Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2016; 15(3): 141–145. https://doi.org/10.18821/16813456-2016-15-3-141-145 (In Russ.).]20.Костенко E. В., Полунин В. С., Полунина Н. В. Влияние сопутствующей заболеваемости на особенности реабилитационного процесса после инсульта. Лечебное дело. 2017; (4): 27–33. [Kostenko E. V., Polunin V. S., Polunina N. V. The influence of concomitant morbidity on the features of the rehabilitation process after stroke. Lechebnoe delo. 2017; (4): 27–33 (In Russ.).]21.Румянцева С. А., Оганов Р. Г., Силина Е. В., Ступин В. А., Болевич С. Б., Орлова А. С., Кабаева Е. Н., Волик С. А., Сохова О. Н., Кубочкин А. Ю. Сердечно-сосудистая патология при остром инсульте (некоторые аспекты распространенности, профилактики и терапии). Кардиоваскулярная терапия и профилактика 2014; 13(4): 47–53. https://doi.org/10.15829/1728-8800-2014-4-47-53 [Rumjantseva S. A., Oganov R. G., Silina E. V., Stupin V. A., Bolevitch S. B., Orlova A. S., Kabaeva E. N., Volik S. A., Sokhova O. N., Kubotchkin A. Yu. Cardiovascular pathology in acute stroke (issues on prevalence, prevention and treatment). Cardiovascular Therapy and Prevention. 2014; 13(4): 47–53. https://doi.org/10.15829/1728-8800-2014-4-47-53 (In Russ.).]22.James P. A., Oparil S., Carter B. L. et al. Evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the Eighth Joint National Committee (JNC8). JAMA. 2014; 311(5): 507–520. https://doi.org/10.1001/jama.2013.284427.23.Migdady I., Russman A., Buletko A. B. Atrial Fibrillation and Ischemic Stroke: A Clinical Review. Seminars in Neurology. 2021; 41(4): 348–364. https://doi.org/10.1055/s-0041-1726332.24.Малюкова Т. И. Реакция сердечно-сосудистой системы на стрессовые воздействия. Современные проблемы науки и образования. 2020; (6): 194 c. https://doi.org/10.17513/spno.30248 [Malyukova T. I. Response of the cardiovascular system to stress influences. Modern Problems of Science and Education. 2020; (6): 194 p. https://doi.org/10.17513/spno.30248 (In Russ.).]25.Морозов В. В., Серяпина Ю. В., Кравченко Ю. Л., Тарков С. М., Бессмельцев В. П., Катасонов Д. Н., Слуев В. А. Телемедицина в кардиологии: новые перспективы. Фундаментальные исследования. 2013; 7(3): 589–593. [Morozov V. V., Seryapina Y. V., Kravchenko Y. L., Tarkov S. M., Bessmeltsev V. P., Katasonov D. N., Sluev V. A. Telemedicine in cardiology: new perspectives. Fundamental Research. 2013[7(3)]: 589–593. (In Russ.).]26.Прекина В. И., Чернова И. Ю. Нарушения ритма сердца у пациентов с ишемическим инсультом. Современные проблемы науки и образования. 2018; (5): 26 c. [Prekina V. I., Chernova I. Y. Of arrhythmias in patients with ischemic stroke. Modern Problems of Science and Education. 2018; (5): 26 p. (In Russ.).]27.Дубенко О. Е., Ракова И. А. Инсульт и кардиальная дисфункция. Медицина неотложных состояний. 2011; 1–2 (32–33): 124–132. [Dubenko O. E., Rakova I. A. Stroke and cardiac dysfunction. Meditsina Neotlozhnykh Sostoyaniy. 2011; 1–2(32–33): 124–132 (In Russ.)].28.Хатькова С. Е., Костенко Е. В., Акулов М. А., Дягилева В. П., Николаев Е. А., Орлова А. С. Современные аспекты патофизиологии нарушений ходьбы у пациентов после инсульта и особенности их реабилитации. Журнал неврологии и психиатрии им. С. С. Корсакова. 2019; 119 (12–2): 43–50. https://doi.org/10.17116/jnevro201911912243 [Khatkova S. E., Kostenko E. V., Akulov M. A., Diagileva V. P., Nikolaev E. A., Orlova A. S. Modern aspects of the pathophysiology of walking disorders and their rehabilitation in post-stroke patients. Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova. 2019; 119 (12–2): 43–50. https://doi.org/10.17116/jnevro201911912243 (In Russ.).]29.Varma N., Cygankiewicz I., Turakhia M. P. et al. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on Health in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circulation: Arrhythmia and Electrophysiology. 2021; 14(2): e009204. https://doi.org/10.1161/CIRCEP.120.009204.