Changes in rest and exercise myocardial perfusion and left ventricular function 3 to 26 weeks after clinically uncomplicated acute myocardial infarction: Effects of exercise training

doi:10.1016/S0002-9149(84)80123-X

The American Journal of Cardiology

Volume 54, Issue 8, 1 November 1984, Pages 943-950

https://doi.org/10.1016/S0002-9149(84)80123-X Get rights and content

The effects of exercise training on exercise myocardial perfusion and left ventricular (LV) function in the first 6 months after clinically uncomplicated acute myocardial infarction (AMI) were assessed in 53 consecutive men aged 55 ± 9 years. Symptom-limited treadmill exercise with thallium myocardial perfusion scintigraphy and symptom-limited upright bicycle ergometry with equilibrium gated radionuclide ventriculography were performed 3, 11 and 26 weeks after AMI by 23 men randomized to training and 30 randomized to no training. Peak cycle capacity increased in both groups between 3 and 26 weeks (p <0.01), but reached higher levels in trained than in untrained patients (803 ± 149 vs 648 ± 182 kg-m/min, p <0.01). Reversible thallium perfusion defects were significantly more frequent at 3 than at 26 weeks: 59% and 36% of patients, respectively (p <0.05), without significant intergroup differences. Values of LV ejection fraction at rest, submaximal and peak exercise did not change significantly in either group. The increase in functional capacity, i.e., peak treadmill or bicycle workload, that occurred 3 to 26 weeks after infarction was significantly correlated with the increase in peak exercise heart rate (p <0.001), but not with changes in myocardial perfusion or LV function determined by radionuclide techniques. Changes in myocardial perfusion or LV function do not appear to account for the improvement in peak functional capacity that occurs within the first 6 months after clinically uncomplicated AMI.

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Cited by (37)

Effect of exercise training on ventricular function, dyssynchrony, resting myocardial perfusion, and clinical outcomes in patients with heart failure: A nuclear ancillary study of Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION); design and rationale
2007, American Heart Journal
Citation Excerpt :
Yet, there are limited data regarding the noninvasive assessment of these changes and the overall effects of exercise on myocardial perfusion. Underpowered studies evaluating the effects of exercise on myocardial perfusion and function in patients with cardiomyopathy have been controversial, indicating both benefit19-21 and no effect.22,23 In patients who derived benefit from exercise, those with the highest thallium activity scores at baseline had the largest gains in functional capacity.
Technetium Tc 99m gated single photon emission computed tomography (SPECT) has become the cornerstone of noninvasive risk stratification in patients with ischemic heart disease, but its role in patients with heart failure is not as well established.
This study is a substudy of the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) trial—a National Institutes of Health/National Heart, Lung, and Blood Institute–funded randomized controlled trial—designed to evaluate the role of exercise training in patients with heart failure due to left ventricular dysfunction. For this substudy, a total of 300 patients distributed on an approximately 1:1 basis between the exercise training and usual care arms of HF-ACTION will undergo resting technetium Tc 99m gated SPECT at baseline and 12 months to compare changes in left ventricular function with exercise training. These changes, along with baseline data, will be correlated with changes in exercise parameters, inflammatory markers, and clinical outcomes: death, cardiovascular hospitalization, and quality of life scores. In a subset of patients, first-pass radionuclide ventriculography will be obtained to assess the relationship between ventricular dyssynchrony, ejection fraction, changes in exercise parameters, and outcomes.
The role of nuclear imaging in patients with heart failure remains poorly defined. This substudy aims to harness the power of a large heart failure trial (HF-ACTION) to further delineate the utility of technetium Tc 99m gated SPECT imaging and first-pass radionuclide ventriculography for predicting important clinical outcomes in this population.
Return to full normal activities including work at two weeks after acute myocardial infarction
2006, American Journal of Cardiology
Citation Excerpt :
Froelicher et al20 reported a modest change in myocardial perfusion and function in a select group of patients who underwent an exercise program that lasted 1 year after AMI. However, others have reported no effect of exercise training on left ventricular ejection fraction after AMI.21,22 It is well established that patients who attain only a low workload on exercise testing after an AMI have a high risk of subsequent cardiac events compared with patients who attain a good workload.
Patients are generally advised to return to full normal activities, including work, 6 to 8 weeks after acute myocardial infarction (AMI). We assessed the outcomes of early return to normal activities, including work at 2 weeks, after AMI in patients who were stratified to be at a low risk for future cardiac events. Patients were considered for randomization before discharge if they had no angina, had left ventricular ejection fraction >40%, a negative result from a symptom-limited exercise stress test for ischemia (<2 mm ST depression) at 1 week, and achieved >7 METs. Patients with left ventricular ejection fraction <40% were included only if they did not have inducible ventricular tachycardia at electrophysiologic studies. Seventy-two patients were randomized to return to normal activities at 2 weeks and 70 patients to undergo standard cardiac rehabilitation and return to normal activities at 6 weeks after AMI. There were no deaths or heart failure in either group. There was no significant difference in the incidence of reinfarction, revascularization, left ventricular function, lipids, body mass index, smoking, or exercise test results at 6 months. In conclusion, return to full normal activities, including work at 2 weeks, after AMI appears to be safe in patients who are stratified to a low-risk group. This should have significant medical and socioeconomic implications.
Evolution of systolic function and myocardial perfusion, evaluated by gated-SPECT, in the first year after acute myocardial infarction
2003, Revista Espanola de Cardiologia
La función sistólica ventricular izquierda y la perfusión miocárdica pueden experimentar cambios durante el seguimiento y la evolución de un infarto agudo de miocardio. El objetivo de este estudio es su valoración mediante gated-SPECT.
Se ha estudiado a 74 pacientes consecutivos con un primer infarto agudo de miocardio no complicado (49 inferolaterales y 25 anteriores) mediante ^99mTc-tetrofosmina de esfuerzo-reposo y gated-SPECT de reposo antes del alta hospitalaria y al año de evolución.
Entre el primer y el segundo estudios, la fracción de eyección aumentó > 5% en un 51% de los infartos inferolaterales y en un 28% de los infartos anteriores no revascularizados. El aumento de la FE (de 48,4 ± 8% a 54,6 ± 8,7%; p < 0,0001; diferencia media, 6,2; IC del 95%, 2,8–9,5) y el descenso del volumen sistólico (de 51,3 ± 19,2 ml a 44,3 ± 19,4 ml; p = 0,001; diferencia media, 7,67; IC del 95%, 1,5–13,8) alcanzaron valores estadísticamente significativos en los infartos inferolaterales. Los índices de perfusión en reposo en la región del infarto mejoraron entre los dos estudios en los infartos inferiores (de 2,3 ± 0,57 a 2,17 ± 0,58; p = 0,004; diferencia media, 0,18; IC del 95%, 0,003–0,36), sin cambios en los índices de isquemia.
La función sistólica ventricular izquierda puede cambiar durante el primer año de evolución, mejorando especialmente en los infartos inferolaterales. En la mitad de éstos, pero sólo en una cuarta parte de los anteriores, la fracción de eyección aumentó más de un 5% entre el primer y el segundo estudios. Esta mejoría se asoció a un incremento de la perfusión miocárdica en reposo.
Systolic function and myocardial perfusion are evaluated before hospital discharge and can change during follow-up. The purpose of this study was to evaluate these parameters by gated-SPECT in the first year after acute myocardial infarction.
We studied 74 consecutive patients with a first uncomplicated acute myocardial infarction (49 infero-lateral and 25 anterior) by stress-rest ^99mTc-tetrofosmin and rest-gated-SPECT before hospital discharge (6–8 days after admission) and one year after myocardial infarction.
The ejection fraction (EF) increased > 5% in 51% of infero-lateral infarcts and 28% of non-revascularized anterior infarcts. EF increased significantly (48.4 ± 8% to 54.6 ± 8.7%; p < 0.0001, mean difference: 6.2; 95% IC, 2.8–9.5) and systolic volume decreased (51.3 ± 19.2 ml to 44.3 ± 19.4 ml; p = 0.001; mean diff.: 7.67; 95% IC, 1.5–13.8) in infero-lateral infarctions. The rest perfusion index in the necrotic region improved (2.3 ± 0.57 to 2.17 ± 0.58; p = 0.004; mean diff.: 0.18; 95% IC, 0.003–0.36) in infero-lateral infarcts and the ischemia index remained unchanged between the first and second studies.
Left ventricular systolic function can change during the first year of evolution, a significant improvement being seen in infero-lateral infarctions. The ejection fraction increased > 5% in half of these patients, as opposed to only a quarter of anterior infarctions. This improvement was associated to increased myocardial perfusion at rest.
Exercise training following myocardial infarction improves myocardial perfusion assessed by thallium-201 scintigraphy
2002, International Journal of Cardiology
Aim: We assessed the effects of a 6-week exercise programme on the thallium-201 myocardial perfusion characteristics of patients following myocardial infarction. Methods: Twenty-five patients presenting with a first acute myocardial infarction were randomised into two groups: (i) those undergoing a supervised exercise training programme over 6 weeks (n=15) and (ii) a control group who did not attend the exercise programme (n=10). All underwent three sequential stress thallium myocardial perfusion scans at 10 days, 6 weeks and 3 months after infarction. The stress conditions were identical on each occasion. The images were analysed using a polar plot with a computer assisted algorithm comparing stress and redistribution data. Values for extent, severity and percentage redistribution of the thallium images were generated. Results: A total of 29 perfusion defects were identified, 18 in the exercise group and 11 in the control group. Over 3 months in the exercise group the mean extent of the stress image defect fell from 109±64 to 95±51 pixels (P<0.05) while in the control group there was an increase from 133±57 to 144±57 pixels (P=ns). Stress defect severity fell in the exercise group from 581±417 to 494±346 S.D. (P<0.05) but increased in the control group from 765±494 to 877±543 S.D. (P=ns). On redistribution imaging in the exercise group a significant decrease was observed in both extent (94±56 to 76±43 pixels (P<0.05)) and severity (541±387 to 438±291 S.D. (P<0.05)) of the defects. However in the control group no significant change was observed for extent (125±54 to 125±52 pixels) or severity (745±485 to 820±503 S.D.) of the redistribution defects (P=ns). Reversibility of the defects increased slightly in both the exercise group (from 14.6±17 to 17.5±20%) and the control group (5.2±5 to 9.6 $+$ 10%) (P=ns). Conclusion: Following myocardial infarction a 6-week exercise programme improves myocardial perfusion characteristics. An exercise programme should be integrated into cardiac rehabilitation protocols for patients after infarction.
ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina
1999, Journal of the American College of Cardiology
Effects of cardiac rehabilitation phase III. Retrospective study of 63 cases
1999, Annales de Readaptation et de Medecine Physique
Dans cette étude, rétrospective et non contrôlée, nous avons tenté d'évaluer l'efficacité de la réadaptation cardiaque de phase III sur l'aptitude physique des patients coronariens et de déterminer par quels facteurs elle est influencée.
Nous avons pu disposer de 63 dossiers complets et exploitables. Les patients ont été répartis en trois groupes selon le type de prise en charge thérapeutique (infarctus, angioplastie et pontage), puis en deux groupes en fonction de leur âge. Tous ont effectué un test d'effort au début du programme de gymnastique et après un an.
En comparant les résultats du test d'effort initial et du test final, nous avons constaté une diminution de la fréquence cardiaque à l'effort pour une même charge de travail, une augmentation de la charge maximale de travail (+ 24 %; p < 0,001), des équivalents métaboliques de repos (+ 19 %; p < 0,001) et de la VO₂ max (+ 23 %, p < 0,001 ). Les mêmes changements significatifs sont observés dans les trois groupes de patients et sont indépendants de leur âge.
Après prise en charge en réadaptation cardiaque ambulatoire de phase III, il y a un effet favorable et significatif sur l'aptitude physique des patients étudiés.
The aim of this retrospective uncontrolled study is to evaluate the benefits of the phase III cardiac rehabilitation ambulatory program on the patients physical condition and to determine the influence of the cardiac pathology and of the patient age.
We analysed the files of 63 coronary patients who take part to the program during a period of one year. These patients are divided in three groups according to their cardiac treatment (myocardial infarction, PTCA, coronary bypass), and in two groups according to their age. All patients had a bicycle ergometry evaluation at the beginning and after one year.
We observed a better hemodynamic response and a significant improvement of the physical performance during ergometry which was independent of the underlying cardiac treatment and of the patient age.
The phase III cardiac rehabilitation ambulatory program was associated with a significant better performance and outcome in the enrolled patients.

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^*: This study was supported by Grant HL 18907 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and by a grant from the PepsiCo Foundation, Purchase, New York. This work was performed while Dr. Hung was an Overseas Fellow supported by the Postgraduate Foundation in Medicine, The University of Sydney, Sydney, Australia. His current address: Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Western Australia 6009.

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Changes in rest and exercise myocardial perfusion and left ventricular function 3 to 26 weeks after clinically uncomplicated acute myocardial infarction: Effects of exercise training*

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Research related to rehabilitation

Circulation

Physician supervised exercise programs in rehabilitation of patients with coronary heart disease

JAMA

Physical conditioning following myocardial infarction

Adv Cardiol

Circulatory adjustments to dynamic exercise and effect of physical training in normal subjects and in patients with coronary artery disease

Prog Cardiovasc Dis

Physiological effects of training: general circulatory adjustments

Radionuclide perfusion images before and after cardiac rehabilitation

Aviat Space Environ Med

Effects of exercise training on ventricular function in patients with recent myocardial infarction

Circulation

Cardiovascular response to repeated treadmill exercise testing soon after myocardial infarction

Circulation

Improvement in aerobic capacity soon after myocardial infarction

J Cardiac Rehab