Article

Several studies suggested that exercise training might improve
myocardial perfusion by inducing coronary vascular adaptations or enhancing
collateralization. However, these findings were obtained in patients with chronic
coronary artery disease using thallium-201 myocardial perfusion scintigraphy. We
evaluated whether a long-term exercise-based cardiac rehabilitation (CR) started
early (9 +/- 3 days) after ST elevation acute myocardial infarction (STEMI)
improves myocardial perfusion and left ventricular (LV) function, evaluated by
gated single-photon emission computed tomography (SPECT) imaging. DESIGN:
Randomized controlled study. METHODS: Fifty patients with recent STEMI were
randomized into two groups:
24 enrolled in a 6-month exercise-based CR programme
(group T) and 26 discharged with generic instructions for maintaining physical
activity and correct lifestyle (group C). All patients underwent cardiopulmonary
exercise test and gated SPECT within 3 weeks after STEMI and at 6-month follow
up. RESULTS: At follow up, group T showed a significant reduction of
stress-induced ischaemia (p < 0.01) and an improvement in resting and post-stress
wall motion (both p < 0.005) and resting (p < 0.05) and post-stress wall
thickness (p < 0.005) score indexes. At follow up, group T showed an improvement
in peak oxygen consumption (p < 0.0001), O(2) pulse (p < 0.05), and in the slope
of increase in ventilation over carbon dioxide output (p < 0.001). No changes in
myocardial perfusion parameters, LV function, and cardiopulmonary indexes were
observed in group C at follow up. CONCLUSIONS: Six months of exercise training
early after STEMI reduces stress-induced ischaemia and improves LV wall motion
and thickness. Exercise-induced changes in myocardial perfusion and function were
associated with the absence of unfavourable LV remodelling and with the
improvement of cardiovascular functional capacity.

Langue : ANGLAIS