ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2018-4-221-228ssmu-1995Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESПрименение нагрузочного тестирования у пациентов после коронарного шунтирования для оценки эффективности операции, определения реабилитационных возможностей и прогнозаThe use of stress test in patients after coronary artery bypass grafting to assess the effectiveness of surgery, determination of rehabilitation possibilities and prognosishttps://orcid.org/0000-0002-6868-4205ИноземцеваА. А.InozemtsevaA. A.

Иноземцева Анастасия Анатольевна, кандидат медицинских наук, научный сотрудник, лаборатория реабилитации, отдел мультифокального атеросклероза, НИИ КПССЗ; Кемеровский государственный медицинский университет

650002, г. Кемерово, Сосновый бульвар, 6, 

650056, г. Кемерово, ул. Ворошилова, 22а

Inozemtseva Anastasya A., PhD, Junior Resecher, Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University

6, Sosnovui Blv., Kemerovo, 650002, 

22а, Vorochilov Str., Kemerovo, 650056

nastya060988@yandex.ruНаучно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний (НИИ КПССЗ); Кемеровский государственный медицинский университетРоссияResearch Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical UniversityRussian Federation201824122018174221228Copyright © Иноземцева А.А., 20182018Иноземцева А.А.Inozemtseva A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/1995

В обзоре приводятся сведения о современных взглядах на использование нагрузочного тестирования c целью определения программ, сроков реабилитации, оценки прогноза у пациентов, перенесших коронарное шунтирование (КШ). Опыт зарубежных и российских клиник демонстрирует необходимость и востребованность нагрузочного тестирования у данной категории пациентов. Однако на сегодняшний день не существует четких рекомендаций относительно сроков и методов нагрузочного тестирования у пациентов, перенесших КШ. Широкое внедрение нагрузочного тестирования в целом и спировелоэргометрии в частности в практическую медицину позволит составлять персонифицированные программы тренировок, оценивать у пациента прогноз, реабилитационный и трудовой потенциал.

The review provides the data on current approaches on the use of stress tests to determine the programs, rehabilitation terms and the prognosis in patients who have undergone coronary artery bypass grafting (CABG). The experience of foreign and Russian clinics shows the necessity and relevance of stress testing in this category of patients. However, currently there are no clear recommendations on the terms and methods of stress testing in patients who underwent CABG. The widespread introduction of stress testing in general and spiroveloergometry in particular into practical medicine will allow for the production of personalized training programs and for the evaluatation of the patient’s prognosis, rehabilitation and labour potential.

нагрузочные тестыкардиореабилитациякоронарное шунтированиефизические тренировкиспировелоэргометрияstress testscardiac rehabilitationcoronary artery bypass graftingphysical trainingsspiroveloergometryReferencesБокерия Л.А., Ступаков И.Н., Гудкова Р.Г. Особенности статистики службы сердечно-сосудистой и рентгенýндоваскулярной хирургии в РФ. Здравоохранение. 2013; 5: 22–32.Bokeriya L.A., Stupakov I.N., Gudkova R.G. Features of statistics of the service of cardiovascular and endovascular surgery in the Russian Federation. Zdravoohranenie. 2013; 5: 22–32 (in Russ.).Акчурин Р.С., Ширяев А.А., Васильев В.П., Галяутдинов Д.М., Власова Э.Е. Современные тенденции в коронарной хирургии. Патология кровообращения и кардиохирургия. 2017; 21 (3S): 34–44. DOI: 10.21688/1681-3472-2017-3S-34-44.Akchurin R.S., Shiryaev A.A., Vasiliev V.P., Galyautdinov D.M., Vlasova E.E. Modern trends in coronary surgery. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2017; 21 (3S): 34–44. DOI: 10.21688/1681-3472-2017-3S-34-44 (in Russ.).Бокерия Л.А., Бухарин В.А., Работников В.С., Алшибая М.Д. Хирургическое лечение больных ишемической болезнью сердца с поражением брахиоцефальных артерий. М.: НЦССХ им. А.Н. Бакулева РАМН, 2006: 176.Bokeriya L.A., Bukharin V.A., Rabotnikov V.S., Alshibaya M.D. Surgical treatment of patients with ischemic heart disease with brachiocephalic arteries. Moscow: NTsSSKhim. A.N. Bakuleva RAMN Publ., 2006: 176 (in Russ.).Osnabrugge R.L., Kappetein A.P., Head S.J., Kolh P. Doing better in more complex patients: leading the way for QUIP. Eur. J. Cardiothorac. Surg. 2016; 49 (2): 397–398. DOI: 10.1093/ejcts/ezv262.Osnabrugge R.L., Kappetein A.P., Head S.J., Kolh P. Doing better in more complex patients: leading the way for QUIP. Eur. J. Cardiothorac. Surg. 2016; 49 (2): 397–398. DOI: 10.1093/ejcts/ezv262.Акчурин Р.С., Ширяев А.А., Васильев В.П., Галяутдинов Д.М., Саличкин Д.В. Коронарное шунтирование с применением операционного микроскопа при диффузном поражении коронарных артерий. Евразийский кардиологический журнал. 2017; 3: 18–19.Akchurin R.S., Shiryaev A.A., Vasiliev V.P., Galyautdinov D.M., Salichkin D.V. Coronary shunting with the use of an operating microscope for diffuse lesions of the coronary arteries. Eurasian Нeart Journal. 2017; 3: 18–19 (in Russ.).Гайфулин Р.А., Сумин А.Н., Иванов С.В., Барбараш Л.С. Выживаемость после хирургического лечения больных с мультифокальным атеросклерозом в различных возрастных группах. Комплексные проблемы сердечно-сосудистых заболеваний. 2017; 2: 6–18. DOI: 10.17802/2306-1278-2017-2-6-18. URL: elibrary.ru/download/elibrary_29422229_92494637.pdfGajfulin R.A., Sumin A.N., Ivanov S.V., Barbarash L.S. Survival after surgical treatment of multifocal atherosclerosis in different age groups. Complex Issues of Cardiovascular Diseases. 2017; 2: 6–18 (in Russ.). DOI: 10.17802/2306-1278-2017-2-6-18. URL: elibrary.ru/download/elibrary_29422229_92494637.pdfБойцов С.А., Самородская И.В. Сравнение показателей смертности от инфаркта миокарда в регионах Российской Федерации в 2006 и 2015 гг. Профилактическая медицина. 2017; 20 (3): 11–16. DOI: 10.17116/profmed201720311-16Boitsov S.A., Samorodskaya I.V. Comparison of mortality rate from myocardial infarction in the regions of the Russian Federation in 2006 and 2015. Profilakticheskaya meditsina. 2017; 20 (3): 11– 16. DOI: 10.17116/profmed201720311-16 (in Russ.).Montalescot G., Andersen H.R., Antoniucci D., Betriu A., de Boer M.J., Grip L. et al. Recommendations on percutaneous coronary intervention for the reperfusion of acute ST elevation myocardial infarction. Heart. 2004; 90: 18–27. DOI: 10.1136/hrt.2003.016014. URL: p.360pubmed.com/pmc/articles/PMC1768296/Montalescot G., Andersen H.R., Antoniucci D., Betriu A., de Boer M.J., Grip L. et al. Recommendations on percutaneous coronary intervention for the reperfusion of acute ST elevation myocardial infarction. Heart. 2004; 90: 18–27. DOI: 10.1136/hrt.2003.016014. URL: p.360pubmed.com/pmc/articles/PMC1768296/Yates B.C., Pozehl B., Kupzyk K., Epstein C.M., Deka P. Are heart failure and coronary artery bypass surgery patients meeting physical activity guidelines? Rehabil. Nurs. 2017; 42 (3): 119–124. DOI: 10.1002/rnj.257.Yates B.C., Pozehl B., Kupzyk K., Epstein C.M., Deka P. Are heart failure and coronary artery bypass surgery patients meeting physical activity guidelines? Rehabil. Nurs. 2017; 42 (3): 119–124. DOI: 10.1002/rnj.257.McGregor G., Nichols S., Hamborg T., Bryning L., Tudor-Edwards R., Markland D. et al. High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicenter randomised controlled trial and economic evaluation. BMJ Open. 2016; 6 (11): 128–143. DOI: 10.1136/bmjopen-2016-012843. URL: p.360pubmed.com/pmc/articles/PMC5129054.McGregor G., Nichols S., Hamborg T., Bryning L., Tudor-Edwards R., Markland D. et al. High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicenter randomised controlled trial and economic evaluation. BMJ Open. 2016; 6 (11): 128–143. DOI: 10.1136/bmjopen-2016-012843. URL: p.360pubmed.com/pmc/articles/PMC5129054.Huang S.C., Wong M.K., Lin P.J., Tsai F.C., Chu J.J., Wu M.Y. et al. Short-term intensive training attenuates the exercise-induced interaction of mono-1/2 cells and platelets after coronary bypass in cardiac patients. Thromb. Haemost. 2017; 117 (9): 1761–1771. DOI: 10.1160/th17-03-0184.Huang S.C., Wong M.K., Lin P.J., Tsai F.C., Chu J.J., Wu M.Y. et al. Short-term intensive training attenuates the exercise-induced interaction of mono-1/2 cells and platelets after coronary bypass in cardiac patients. Thromb. Haemost. 2017; 117 (9): 1761–1771. DOI: 10.1160/th17-03-0184.Bjarnason-Wehrens B., Mc Ge E.H., Zwisler A.D., Piepoli M.F., Benzer W., Schmid J.P. et al. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur. J. Cardiovasc. Prev. Rehabil. 2010; 17 (4): 410–418. DOI: 10.1097/hjr.0b013e328334f42d.Bjarnason-Wehrens B., Mc Ge E.H., Zwisler A.D., Piepoli M.F., Benzer W., Schmid J.P. et al. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur. J. Cardiovasc. Prev. Rehabil. 2010; 17 (4): 410–418. DOI: 10.1097/hjr.0b013e328334f42d.Суджаева С.Г., Суджаева О.А., Губич Т.С., Казаева Н.А., Ганич М.А. Национальные рекомендации. Реабилитация больных кардиологического и кардиохирургического профиля (кардиологическая реабилитация). Минск, 2010: 236.Sudzhaeva S.G., Sudzhaeva O.A., Gubich T.S., Kazaeva N.A., Ganich M.A. National recommendations. Rehabilitation of cardiological and cardiac surgical patients (cardiac rehabilitation). Minsk, 2010: 236 (in Russ.).Hillis L.D., Smith P.K., Anderson J.L., Bittl J.A., Bridges C.R., Byrne J.G. et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary. Circulation. 2011; 6: 654–735. DOI: 10.1016/j.jacc.2011.08.008. URL: www.sciencedirect.com/science/article/pii/S0735109711029482?via%3Dihub.Hillis L.D., Smith P.K., Anderson J.L., Bittl J.A., Bridges C.R., Byrne J.G. et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary. Circulation. 2011; 6: 654–735. DOI: 10.1016/j.jacc.2011.08.008. URL: www.sciencedirect.com/science/article/pii/S0735109711029482?via%3Dihub.Windecker S., Kolh P., Alfonso F., Collet J.-P., Cremer J., Falk V. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2014; 35: 2541–2619. DOI: 10.1093/eurheartj/ehu278. URL: academic.oup.com/eurheartj/article/35/37/2541/581070.Windecker S., Kolh P., Alfonso F., Collet J.-P., Cremer J., Falk V. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2014; 35: 2541–2619. DOI: 10.1093/eurheartj/ehu278. URL: academic.oup.com/eurheartj/article/35/37/2541/581070.Бокерия Л.А., Аронов Д.М. Российские клинические рекомендации. Коронарное шунтирование больных ишемической болезнью сердца: реабилитация и вторичная профилактика. М., 2016: 67.Bokeriya L.A., Aronov D.M. Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. Moscow, 2016: 67 (in Russ.).Помешкина С.А., Кондрикова Н.В., Крупянко Е.В., Каган Е.С., Барбараш О.Л. Анализ подходов к оценке стойкой утраты трудоспособности у пациентов, подвергшихся коронарному шунтированию. Кардиология. 2013; 53 (7): 62–66. URL: elibrary.ru/download/elibrary_20503334_76137368.pdf.Pomeshkina S.A., Kondrikova N.V., Krupyanko E.V., Kagan E.S., Barbarash O.L. Analysis of аpproaches to аssessment of рersistent loss of capacity to work in patients who had undergone coronary bypass surgery. Cardiology. 2013; 7: 62–66 (in Russ.). URL: elibrary.ru/download/elibrary_20503334_76137368.pdf.Zielinska D., Bellwon J., Rynkiewicz A., Elkady M.A. Prognostic value of the six-minute walk test in heart failure patients undergoing cardiac surgery: a literature review. Rehabil. Res. Pract. 2013; 2013: 965–969. DOI: 10.1155/2013/965494. URL: www.hindawi.com/journals/rerp/2013/965494/Zielinska D., Bellwon J., Rynkiewicz A., Elkady M.A. Prognostic value of the six-minute walk test in heart failure patients undergoing cardiac surgery: a literature review. Rehabil. Res. Pract. 2013; 2013: 965–969. DOI: 10.1155/2013/965494. URL: www.hindawi.com/journals/rerp/2013/965494/Rocco I.S., Viceconte M., Pauletti H.O., Matos-Garcia B.C., Marcondi N.O., Bublitz C. et al. Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery. Disabil Rehabil. 2017; 26: 1–7. DOI: https://doi.org/10.1080/09638288.2017.1401673. URL: www.tandfonline.com/doi/full/10.1080/09638288.2017.1401673.Rocco I.S., Viceconte M., Pauletti H.O., Matos-Garcia B.C., Marcondi N.O., Bublitz C. et al. Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery. Disabil Rehabil. 2017; 26: 1–7. DOI: https://doi.org/10.1080/09638288.2017.1401673. URL: www.tandfonline.com/doi/full/10.1080/09638288.2017.1401673.Аронов Д.М., Лупанов В.П. Функциональные пробы в кардиологии. 2-е изд. М.: МЕДпресс-информ, 2003: 296.Aronov D.M., Lupanov V.P. Functional tests in cardiology. 2nd ed. Moscow: MEDpress-inform Publ., 2003: 296 (in Russ.).Fletcher G.F., Ades P.A., Kligfield P., Arena R., Balady G.J., Bittner V.A. et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013; 128 (8): 873–934. doi.org/10.1161/hc3901.095960. URL: circ.ahajournals.org/content/104/14/1694.Fletcher G.F., Ades P.A., Kligfield P., Arena R., Balady G.J., Bittner V.A. et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013; 128 (8): 873–934. doi.org/10.1161/hc3901.095960. URL: circ.ahajournals.org/content/104/14/1694.Нечаева Г.И., Фисун Н.И., Друк И.В., Янковский Е.Б., Морозов С.Л. Сравнительная оценка функциональных нагрузочных проб в диагностике стенокардии: обзор. Сердце. 2008; 7 (2): 91–97. URL: elibrary.ru/download/elibrary_10441649_77631509.pdfNechaeva G.I., Fisun N.I., Druk I.V., Yankovskiyi E.B., Morozov S.L. Comparative evaluation of functional stress tests in the diagnosis of angina: an overview. Heart. 2008; 7 (2): 91–97 (in Russ.). URL: elibrary.ru/download/elibrary_10441649_77631509.pdfData D., Normandin E., Zu Wallack R. Cardiopulmonary exercise testing in the assessment of exertional dyspnea. Ann. Thorac. Med. 2015; 10 (2): 77–86. doi. org/10.4103/1817-1737.151438. URL: www.thoracicmedicine.org/article.asp?issn=1817737;year=2015;volume=10;issue=2;spage=77;epage=86;aulast=DattaData D., Normandin E., Zu Wallack R. Cardiopulmonary exercise testing in the assessment of exertional dyspnea. Ann. Thorac. Med. 2015; 10 (2): 77–86. doi. org/10.4103/1817-1737.151438. URL: www.thoracicmedicine.org/article.asp?issn=1817737;year=2015;volume=10;issue=2;spage=77;epage=86;aulast=DattaMyers J., Arena R., Cahalin L.P. Cardiopulmonary exercise testing in heart failure. Curr. Probl. Cardiol. 2015; 40 (8): 322–372. doi.org/10.1016/j.cpcardiol.2015.01.009. URL: www.sciencedirect.com/science/article/pii/S0146280615000109?via%3DihubMyers J., Arena R., Cahalin L.P. Cardiopulmonary exercise testing in heart failure. Curr. Probl. Cardiol. 2015; 40 (8): 322–372. doi.org/10.1016/j.cpcardiol.2015.01.009. URL: www.sciencedirect.com/science/article/pii/S0146280615000109?via%3DihubМухарлямов Ф.Ю., Сычёва М.Г., Рассулова М.А. Программы медицинской реабилитации больных после аортокоронарного шунтирования. Доктор.ру. 2016; 12 (129): 7–10.Mukharlyamov Yu., Sychyova M. G., Rassulova M.A. Programs of medical rehabilitation after coronary artery bypass grafting. Doctor.ru. 2016; 12 (129): 7–10 (in Russ.).Tomazini Nesello P.F., Tairova O., Tairova M., Graciolli L., Baroni A., Comparsi Е. et al. Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs. Open Access Maced J. Med. Sci. 2016; 4 (4): 654–660. doi.org/10.3889/oamjms.2016.125. URL: www.id-press.eu/mjms/article/view/oamjms.2016.125Tomazini Nesello P.F., Tairova O., Tairova M., Graciolli L., Baroni A., Comparsi Е. et al. Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs. Open Access Maced J. Med. Sci. 2016; 4 (4): 654–660. doi.org/10.3889/oamjms.2016.125. URL: www.id-press.eu/mjms/article/view/oamjms.2016.125Ansari B., Qureshi M.A., Zohra R.R. Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction (EF > 50% or < 50%) after coronary artery bypass grafting surgery. Pak. J. Pharm. Sci. 2014; 27 (6): 2157–2163.Ansari B., Qureshi M.A., Zohra R.R. Effect of exercise training program in post-CRET post-CABG patients with normal and subnormal ejection fraction (EF > 50% or < 50%) after coronary artery bypass grafting surgery. Pak. J. Pharm. Sci. 2014; 27 (6): 2157–2163.Salzwedel A., Reibis R., Wegscheider K., Eichler S., Buhlert H., Kaminski S. et al. Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin. Res. Cardiol. 2016; 105 (3): 257–267. doi.org/10.1007/s00392-015-0917-1. URL: link.springer.com/article/10.1007%2Fs00392-015-0917-1Salzwedel A., Reibis R., Wegscheider K., Eichler S., Buhlert H., Kaminski S. et al. Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin. Res. Cardiol. 2016; 105 (3): 257–267. doi.org/10.1007/s00392-015-0917-1. URL: link.springer.com/article/10.1007%2Fs00392-015-0917-1Таран И.Н., Валиева З.С., Мартынюк Т.В., Чазова И.Е. Спировелоýргометрия в стратификации риска пациентов с легочной артериальной гипертензией и хронической тромбоýмболической легочной гипертензией. Евразийский кардиологический журнал. 2017; 4: 86–99. URL: elibrary.ru/download/elibrary_30579592_70575539.pdfTaran I.N., Valieva Z.S., Martynyuk T.V., Chazova I.Ye. Cardiopulmonary exercise testing in risk stratification in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Eurasian Нeart Journal. 2017; 4: 86–99 (in Russ.). URL: elibrary.ru/download/elibrary_30579592_70575539.pdfSkalski J., Allison T.G., Miller T.D. The safety of cardiopulmonary exercise testing in a population with highrisk cardiovascular diseases. Circulation. 2012; 126(21): 2465–2472. doi.org/10.1161/circulationaha.112.110460. URL: circ.ahajournals.org/content/126/21/2465.Skalski J., Allison T.G., Miller T.D. The safety of cardiopulmonary exercise testing in a population with highrisk cardiovascular diseases. Circulation. 2012; 126(21): 2465–2472. doi.org/10.1161/circulationaha.112.110460. URL: circ.ahajournals.org/content/126/21/2465.Tsai S.W., Lin Y.W., Wu S.K. The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery. Clin. Rehabil. 2005; 19 (8): 843–849. doi.org/10.1191/0269215505cr915oa. URL: journals.sagepub.com/doi/10.1191/0269215505cr915oa.Tsai S.W., Lin Y.W., Wu S.K. The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery. Clin. Rehabil. 2005; 19 (8): 843–849. doi.org/10.1191/0269215505cr915oa. URL: journals.sagepub.com/doi/10.1191/0269215505cr915oa.Tsuboi Y., Tanaka H., Nishio R., Sawa T., Terashita D., Nakayama K. et al. Associations of exercise tolerance with hemodynamic parameters for pulmonary arterial hypertension and for chronic thromboembolic pulmonary hypertension. J. Cardiopulm. Rehabil. Prev. 2017; 37 (5): 341–346. doi.org/10.1097/hcr.0000000000000257. URL: insights.ovid.com/crossref?an=01273116-201709000-00008Tsuboi Y., Tanaka H., Nishio R., Sawa T., Terashita D., Nakayama K. et al. Associations of exercise tolerance with hemodynamic parameters for pulmonary arterial hypertension and for chronic thromboembolic pulmonary hypertension. J. Cardiopulm. Rehabil. Prev. 2017; 37 (5): 341–346. doi.org/10.1097/hcr.0000000000000257. URL: insights.ovid.com/crossref?an=01273116-201709000-00008Galie N., Humbert M., Vachieryc J.L., Gibbs S., Lang I., Torbicki A. et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2016; 37 (1): 67–119. doi.org/10.1183/13993003.51032-2015. URL: erj.ersjournals.com/content/46/6/1855Galie N., Humbert M., Vachieryc J.L., Gibbs S., Lang I., Torbicki A. et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2016; 37 (1): 67–119. doi.org/10.1183/13993003.51032-2015. URL: erj.ersjournals.com/content/46/6/1855Tan S.J., Allen J.C., Tan S.Y. Determination of ideal target exercise heart rate for cardiac patients suitable for rehabilitation. Clin. Cardiol. 2017; 40 (11): 1008– 1012. doi.org/10.1002/clc.22758. URL: onlinelibrary.wiley.com/doi/abs/10.1002/clc.22758Tan S.J., Allen J.C., Tan S.Y. Determination of ideal target exercise heart rate for cardiac patients suitable for rehabilitation. Clin. Cardiol. 2017; 40 (11): 1008– 1012. doi.org/10.1002/clc.22758. URL: onlinelibrary.wiley.com/doi/abs/10.1002/clc.22758Корецкий С.Н., Шабалкин Б.В., Жбанов И.В., Стоногин А.В., Овчинников Р.С., Свет А.В. и др. Оценка ýффективности физических тренировок у пациентов группы среднего и высокого риска после аортокоронарного шунтирования с помощью ýргоспирометрии. Кардиология и сердечно-сосудистая хирургия. 2009; 6 (2): 12–15.Koretskiy S.N., Shabalkin B.V., Zhbanov I.V., Stonogin A.V., Ovchinnikov R.S., Svet A.V. et al. Evaluation of physical training efficiency using ergospirometry in patients with moderate or high risk after coronary bypass grafting. Cardiology and Сardiovascular Surgery. 2009; 6 (2): 12–15 (in Russ.).Кербиков О.Б., Аверьянов А.В., Борская Е.Н., Крутова Т.В. Кардиопульмональное нагрузочное тестирование в клинической практике. Клиническая практика. 2012; 2 (10): 58–70.Kerbikov O.В., Averyanov A.V., Borskaya E.N., Krutova T.V. Cardiopulmonary exercise testing in clinical practice. Clinical Рractice. 2012; 2 (10): 58–70 (in Russ.).

The authors declare that there are no conflicts of interest present.