Article

PURPOSE: Despite being repeatedly shown that exercise training (ET) increases
exercise capacity and decreases mortality in many cardiac conditions, not all
patients enjoy the benefits of ET programs. We hypothesized that baseline
cardiovascular mechanic properties, including cardiac systolic and diastolic
functions, arterial mechanics and ventriculoarterial interaction, may have a role
in predicting response to ET. METHODS: Full left ventricular pressure-volume
loops were constructed and arterial mechanics were evaluated using
echocardiographic and tonometric measurements. A cardiopulmonary exercise (CPX)
test was performed before and after the ET program.
RESULTS: Sixty of the 75
patients with coronary artery disease or heart failure diagnoses completed the
study. All of the CPX parameters showed a significant improvement with ET. The
change in oxygen uptake correlated only with arterial parameters, such as
compliance (r = 0.399, P = .002), end-systolic arterial elastance
(r = -0.293, P
= .02), aortic pulse pressure (r = -0.302, P = .02), and brachial pulse pressure
(r = -0.312, P = .01). Receiver-operating characteristics analysis demonstrated
that baseline arterial compliance and brachial pulse pressure predicted a
significantly positive ET result with reasonable sensitivity and specificity.
CONCLUSIONS: Patients with a more compliant arterial system improved their
exercise capacity more with ET. Evaluation of baseline arterial compliance may
facilitate proper patient selection and may define patients who need optimizing
measures for the arterial system before commencing ET. Even a simple blood
pressure measurement may give clues in this regard.

Langue : ANGLAIS