Biochemical Markers in Determining the Rehabilitation Potential of Patients with Obesity after Acute Myocardial Infarction

Abstract

Background: Biochemical markers of inflammation and adipokine imbalance may complement functional assessment during cardiac rehabilitation after acute myocardial infarction (AMI), particularly in patients with obesity. Aims: This study aimed to evaluate how biochemical markers of inflammation and adipokine imbalance influence rehabilitation potential in patients with obesity after acute myocardial infarction (AMI) and to determine whether these markers can improve the early prediction of recovery during cardiac rehabilitation. Study Design: A prospective single-centre study. Place and Duration of Study: The study was conducted at the University Clinic (Myckolaiv, Ukraine) between 2021 and 2025. Methodology: We included 120 patients who had experienced AMI. Seventy patients with class I obesity (BMI 30.0–34.9 kg/m²) formed the main group, while 50 patients with a normal BMI served as controls. All participants underwent standard early cardiac rehabilitation. Functional recovery was assessed using the six-minute walk test (6MWT) and echocardiographic evaluation of left ventricular ejection fraction (LVEF). Biochemical evaluation included high-sensitivity C-reactive protein (hs-CRP), leptin, adiponectin, and markers of oxidative stress. Based on changes in these parameters over three months, an integral rehabilitation potential (RP) index was calculated. Statistical analysis included correlation and regression models to identify independent predictors of recovery. Results: Patients with obesity demonstrated significantly higher levels of systemic inflammation and leptin, alongside reduced adiponectin concentrations, both in the acute phase and at the start of rehabilitation (p < 0.001). They also showed lower exercise tolerance and slightly reduced LVEF. The average RP index was significantly lower in patients with obesity than in individuals without obesity (0.41 ± 0.03 vs. 0.58 ± 0.04; p < 0.01). Low rehabilitation potential (RP < 0.30) was more than three times as common in the obesity group. Regression analysis identified hs-CRP and leptin as the strongest negative predictors of recovery, whereas improvements in 6MWT distance and LVEF had the strongest positive associations. Conclusion: Rehabilitation potential after AMI is not determined solely by myocardial injury but is also associated with systemic inflammation and adipokine imbalance in patients with obesity. Incorporating biochemical markers into rehabilitation assessment may enhance early risk stratification and support more personalised cardiac rehabilitation strategies.