Department of Clinical Medicine, Cardiovascular and Immunological Sciences. Cardiac Rehabilitation Unit, University of Naples Federico II, via S. Pansini 5, Naples, Italy.
Eur J Prev Cardiol. 2012 Dec;19(6):1410-9. doi: 10.1177/1741826711425427. Epub 2011 Sep 30.
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.
Randomized controlled study.
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.
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.
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.
几项研究表明，运动训练可以通过诱导冠状动脉血管适应或增强侧支循环来改善心肌灌注。然而，这些发现是在使用铊-201 心肌灌注闪烁显像术对慢性冠状动脉疾病患者进行的。我们评估了在 ST 段抬高急性心肌梗死（STEMI）后早期（9±3 天）开始的长期基于运动的心脏康复（CR）是否可以改善心肌灌注和左心室（LV）功能，通过门控单光子发射计算机断层扫描（SPECT）成像进行评估。
随机对照研究。
50 例近期发生 STEMI 的患者被随机分为两组：24 例接受 6 个月的基于运动的 CR 方案（组 T），26 例出院后接受维持体力活动和正确生活方式的一般指导（组 C）。所有患者在 STEMI 后 3 周内和 6 个月随访时进行心肺运动试验和门控 SPECT。
随访时，组 T 显示应激诱导的缺血明显减少（p<0.01），静息和应激后壁运动改善（均 p<0.005），静息（p<0.05）和应激后壁厚度评分指数改善（p<0.005）。随访时，组 T 的峰值摄氧量（p<0.0001）、O2 脉冲（p<0.05）和二氧化碳输出增加时通气斜率（p<0.001）均有改善。组 C 在随访时，心肌灌注参数、LV 功能和心肺指标均无变化。
STEMI 后早期 6 个月的运动训练可减少应激诱导的缺血，并改善 LV 壁运动和厚度。运动引起的心肌灌注和功能变化与不利的 LV 重构改善和心血管功能能力的提高有关。
