Cardiac rehabilitation in patients with recent myocardial infarction and left ventricular dysfunction. Hemodynamic aspects

Chronic dynamic exercise improves a functional abnormality of the G stimulatory protein in cardiomyopathic BIO 53.58 Syrian hamsters

BACKGROUND

The effects of chronic exercise training on myocardial contractility and beta-adrenergic signal transduction in hearts with left ventricular dysfunction have not been determined.

METHODS AND RESULTS

Fourteen-week-old cardiomyopathic BIO 53.58 and normal F1B Syrian hamsters underwent 10 weeks of treadmill training and were compared with 24-week-old BIO 53.58 and F1B untrained controls. Left ventricular isovolumic maximum positive dP/dt and peak developed pressure were significantly lower in BIO 53.58 than in F1B controls. Exercise training improved left ventricular contractile indices in BIO 53.58 but not F1B hamsters. The left ventricular beta-adrenergic receptor number (Bmax) was similar in BIO 53.58 and F1B controls. Basal adenylate cyclase activity (ACA) and ACAs stimulated by isoproterenol, 5'-guanylylimidodiphosphate (GppNHp), sodium fluoride, and forskolin were significantly lower in BIO 53.58 than in F1B controls. The functional activity of stimulatory guanine nucleotide-binding protein (Gs), as determined by reconstitution with S49 lymphoma cyc- cell membranes, was significantly lower in BIO 53.58 controls. After 10 weeks of exercise training, Bmax and basal and isoproterenol-stimulated ACAs were unchanged in either BIO 53.58 or F1B hamsters compared with controls. However, in F1B hamsters, training decreased ACAs stimulated by GppNHp, sodium fluoride, and forskolin, with a reduced functional activity of Gs. In contrast, these ACAs increased significantly in association with an enhanced Gs activity in cardiomyopathic BIO 53.58 hamsters after training.

CONCLUSIONS

Chronic exercise training does not change receptor-mediated beta-adrenergic responsiveness in either F1B or BIO 53.58 hamsters. However, exercise training reduces Gs activity in normal F1B hamsters and improves the functional abnormality of Gs in cardiomyopathic BIO 53.58 hamsters. This improvement may potentially contribute to augmented left ventricular contractility in BIO 53.58 after training.

Randomized 4-week exercise program in patients with impaired left ventricular function

BACKGROUND

This study was designed to determine the controlled effects of a short-term exercise rehabilitation program on patients with moderate-to-severe left ventricular dysfunction after a recent myocardial infarction.

METHODS AND RESULTS

Thirty-nine male patients 51 +/- 8 years old with a large anterior myocardial infarction less than 10 weeks old were recruited for the study. The patients were randomly assigned to either one of two training or control groups on the basis of their resting ejection fraction: training, less than 30%; control, less than 30%; training, 31-50%; or control, 31-50%. Patients were evaluated for filling pressures, radionuclide ventriculography, heart volume, echocardiography, and work capacity. Patients who underwent training participated in an intensive 4-week in-hospital exercise program, whereas the control patients were restricted to a minimal activity program. Results indicated that there were no significant improvements in resting, submaximal, and maximal hemodynamic measurements as a result of the program. Mean work capacity and peak oxygen consumption improved significantly in the less-than-30% training group but was accompanied by a significant increase in mean pulmonary wedge pressure. Resting ejection fraction improved markedly in both less-than-30% training and control patients, but ejection fraction measures were not associated with work capacity. Training did not cause further deterioration in ventricular function.

CONCLUSIONS

It was concluded that in the present study, exercise training had little or no effect on hemodynamic measurements and that the training effects achieved in patients with left ventricular dysfunction are most likely due to corrected impaired vasodilation, not necessarily to cardiac function. The importance of using a control group in this type of study and the wide interindividual variations in training responses are emphasized.

Exercise performance of the high risk acute myocardial infarction patient after cardiac rehabilitation

Sixty-five subjects with a recent acute myocardial infarction (AMI), 50 men and 15 women aged 39 to 79 years (mean 62 +/- 9), were entered into a 12-week phase II cardiac rehabilitation program. Group I subjects were those with an ejection fraction greater than 40% (mean 56) and group II subjects were those with an ejection fraction less than 40% (mean 28). Subjects were further classified into those with or without myocardial ischemia (Ia, IIa and Ib, IIb, respectively) based on a treadmill stress test before entry. Work performance during the training sessions was similar for all subgroups, although group IIb had the lowest values for work rate and time of exercise for each individual activity. Subgroup analysis, as determined by a pre- and postprogram treadmill stress test, showed there was no significant difference in time of exercise, peak oxygen consumption and change in submaximal heart rate (decrease) for groups Ia, Ib or IIa. However, group IIb had poor performance in time of exercise (delta = 2 +/- 2 minutes), peak oxygen consumption (delta = 3 +/- 5 ml/min) and submaximal heart rate (delta = 0.4 +/- 17 beats/min) compared with the 3 other subgroups. These subjects also did not demonstrate an improvement of these values in the posttraining period. Patients who have had AMI and have both significant left ventricular dysfunction and myocardial ischemia did not have an adequate training response after 12 weeks of a formal phase II cardiac rehabilitation program.(ABSTRACT TRUNCATED AT 250 WORDS)