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Reduced exercise capacity and clinical outcomes following acute myocardial infarction

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Abstract

Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9 ± 11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed 5 days after the onset of AMI. Reduced exercise capacity was defined as peak VO2 ≤ 12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed. Among 136 patients, reduced exercise capacity (peak VO2 ≤ 12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e’ and larger left atrial dimension. Multivariate logistic analysis showed that E/e’ (OR 1.19, 95% CI 1.09–1.31, p < 0.001) was an independent predictor of reduced exercise capacity (peak VO2 ≤ 12). Median follow-up term was 12 months (IQR 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2 ≤ 12 than those with peak VO2 > 12 (p < 0.001). Reduced exercise capacity following primary PCI in AMI patients is associated with diastolic dysfunction and may lead to poorer clinical outcomes.

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Acknowledgements

This study was supported by a grant from Grant-in-Aid for Scientific Research (KAKENHI) (No. 17K09493) of the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and Japanese Society for the Promotion of Science (JSPA).

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Authors and Affiliations

  1. Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Hiroshi Tashiro, Akihito Tanaka, Hideki Ishii, Naoki Iwakawa, Hiroki Kojima, Takayuki Mitsuda, Kenshi Hirayama, Yusuke Hitora, Kenji Furusawa, Ruka Yoshida & Toyoaki Murohara

  2. Department of Cardiology, Komaki City Hospital, Komaki, Japan

    Hiroshi Tashiro, Nariko Motomura, Kenji Arai, Takeshi Adachi, Takashi Okajima, Motoharu Hayashi, Hajime Imai, Yasuhiro Ogawa & Katsuhiro Kawaguchi

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  1. Hiroshi Tashiro
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Correspondence to Akihito Tanaka.

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Conflict of interest

Hideki Ishii received lecture fees from Astellas Pharma Inc., Astrazeneca Inc., Daiichi-Sankyo Pharma Inc., and MSD K. K. Toyoaki Murohara received lecture fees from Bayel Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Pfizer Japan Inc., Sanofi-aventis K. K., and Takeda Pharmaceutical Co., Ltd. Toyoaki Murohara received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K. K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-aventis K. K., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Tashiro, H., Tanaka, A., Ishii, H. et al. Reduced exercise capacity and clinical outcomes following acute myocardial infarction. Heart Vessels 35, 1044–1050 (2020). https://doi.org/10.1007/s00380-020-01576-2

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