Polyvascular atherosclerosis involvement and cardiac rehabilitation: functional improvement and risk reclassification

Objective: polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a myocardial infarction. To understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Furthermore, we want to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic disease with carotid ultrasound and Ankle Brachial Index (ABI). Design and method: The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Anamnestic, clinical, laboratory and instrumental data were collected. Functional improvement was assessed as the difference in meters walked on the 6-minutes walking test (6MWT) at the beginning (6MWT-1) and at the end of the rehabilitation (6MWT-2). All patients underwent ABI (to evaluate asyntomatic PAD) and carotid ultrasound (to evaluate asyntomatic cerebrovascular disease). Results: Pre-riclassification, polyvascolar patients (13) compared to monovascular (74) were older (70 years vs 59 years, p = 0.01), more frequenly males (100% vs 73%, p<0.001), had more previous recurrent myocardial infarctions (46% vs 8%, p = 0.002) and had a worse performance in terms of 6MWT-1 (428m vs 514m, p = 0.002) and 6MWT-2 (517m vs 597m, p = 0.008). However, absolute functional improvement durgin rehabilitation is imilar between the two group (81m vs 82m, p = 0.919). Following reclassification, 7 patients switched from monovascular (87) to polyvascular (20). Conclusions: Our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.