Issue №2-22, 2023

Original article

https://doi.org/10.38025/2078-1962-2023-22-2-52-65

ECG telemonitoring of Cardiac Risks in Medical Rehabilitation of Stroke Patients: Controlled Study in Parallel Groups

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1 ORCID Irena V. Pogonchenkova 1,2 ORCID Elena V. Kostenko 1 ORCID Liudmila V. Petrova 1 ORCID Natalia V. Neprintseva

1Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department 2Pirogov Russian National Research Medical University


ABSTRACT

INTRODUCTION. Safety and the personal dosing of physical activity are the main aspects of medical rehabilitation in stroke patients.

AIM. 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).

MATERIALS AND METHODS. 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.

RESULTS AND DISCUSSION. 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.

CONCLUSION. 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.


KEYWORDS: cardiac safety, ischemic stroke, telemedicine, medical rehabilitation, comorbidity, electrocardiography, cardiac arrhythmias

Acknowledgments: The study had no sponsorship.

Conflict of interest:: The authors declare no apparent or potential conflicts of interest related to the publication of this article.

For citation:

Погонченкова И. В., Костенко Е. В., Петрова Л. В., Непринцева Н. В. ЭКГ-телемониторинг кар-диальных рисков медицинской реабилитации пациентов, перенесших инсульт: контролируемое исследование в параллель-ных группах. Вестник восстановительной медицины. 2023; 22(2): 52-65. https://doi.org/10.38025/2078-1962-2023-22-2-52-65.[Pogonchenkova I. V., Kostenko E. V., Petrova L. V., Neprintseva N. V. ECG telemonitoring of Cardiac Risks in Medical Rehabilitation of Stroke Patients: Controlled Study in Parallel Groups. Bulletin of Rehabilitation Medicine. 2023; 22(2): 52-65. https://doi.org/10.38025/2078-1962-2023-22-2-52-65 (In Russ.).]

Для корреспонденции: Петрова Людмила Владимировна, E-mail: mnpcsm-f7@zdrav.mos.ru; ORCID: https://orcid.org/0000-0003-0353-553X



References:

  1. 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. 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. 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. 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. 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. 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. Vladzimirsky A. V., Lebedev G. S. Telemedicine. Moscow. 2018: 576 p. (In Russ.).
  14. Vane A. M. Vegetative disorders: clinic, diagnosis, treatment. Moscow. 2003: 752 p. (In Russ.).
  15. 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. 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. 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. 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. 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. 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. 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. 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. 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. Dubenko O. E., Rakova I. A. Stroke and cardiac dysfunction. Meditsina Neotlozhnykh Sostoyaniy. 2011; 1–2(32–33): 124–132 (In Russ.).
  28. 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





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