体育锻炼可改善微血管性心绞痛患者的心肌灌注，但不能改善其左心室功能对运动的反应。

Physical training improves myocardial perfusion but not left ventricular function response to exercise in patients with microvascular angina.

作者信息

Carvalho Eduardo E, Crescêncio Júlio C, Santi Giovani L, Oliveira Luciano F, Schwartzmann Pedro V, Gallo-Junior Lourenço, Marin-Neto José A, Simões Marcus V

机构信息

Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil -

出版信息

Q J Nucl Med Mol Imaging. 2019 Sep;63(3):302-310. doi: 10.23736/S1824-4785.17.02930-2. Epub 2017 Mar 16.

DOI:10.23736/S1824-4785.17.02930-2

PMID:28299921

Abstract

BACKGROUND

Patients with primary microvascular angina (PMA) commonly exhibit abnormal left ventricular function (LVF) during exercise, potentially owing to myocardial ischemia. Herein, we investigated in PMA patients the effect of the reduction of myocardial perfusion disorders, by using aerobic physical training, upon LVF response to exercise.

METHODS

Overall, 15 patients (mean age, 53.7±8.9 years) with PMA and 15 healthy controls (mean age, 51.0±9.4 years) were studied. All subjects were subjected to baseline resting and exercise ventriculography, myocardial perfusion scintigraphy (MPS), and cardiopulmonary testing. PMA group members then participated in a 4-month physical training program and were reevaluated via the same methods applied at baseline.

RESULTS

Baseline left ventricular ejection fraction (LVEF) determinations by ventriculography were similar for both groups (PMA, 67.7±10.2%; controls, 66.5±5.4%; P=0.67). However, a significant rise in LVEF seen in control subjects during exercise (75.3±6.2%; P=0.0001) did not materialize during peak exercise in patients with PMA (67.7±10.2%; P=0.47). Of the 12 patients in the PMA group who completed the training program, 10 showed a significant reduction in reversible perfusion defects during MPS. Nevertheless, LVEF at rest (63.5±8.7%) and at peak exercise (67.3±15.9%) did not differ significantly (P=0.30) in this subset.

CONCLUSIONS

In patients with PMA, reduced left ventricular inotropic reserve observed during exercise did not normalize after improving myocardial perfusion through aerobic physical training.

摘要

背景

原发性微血管性心绞痛（PMA）患者在运动期间通常表现出左心室功能（LVF）异常，这可能是由于心肌缺血所致。在此，我们研究了在PMA患者中，通过有氧体育锻炼减少心肌灌注障碍对LVF运动反应的影响。

方法

总共对15例PMA患者（平均年龄53.7±8.9岁）和15名健康对照者（平均年龄51.0±9.4岁）进行了研究。所有受试者均接受了基线静息和运动心室造影、心肌灌注闪烁显像（MPS）以及心肺测试。PMA组的成员随后参加了为期4个月的体育锻炼计划，并通过与基线时相同的方法进行重新评估。

结果

通过心室造影测定的两组基线左心室射血分数（LVEF）相似（PMA组为67.7±10.2%；对照组为66.5±5.4%；P = 0.67）。然而，对照组受试者在运动期间LVEF显著升高（75.3±6.2%；P = 0.0001），而PMA患者在运动高峰时并未出现这种情况（67.7±10.2%；P = 0.47）。在完成训练计划的PMA组的12例患者中，10例在MPS期间可逆性灌注缺损显著减少。然而，在这一子集中，静息时（63.5±8.7%）和运动高峰时（67.3±15.9%）的LVEF并无显著差异（P = 0.30）。