Role of physiological ischemia training in suppressing ventricular remodeling and ventricular arrhythmia in patients after myocardial infarction: a randomized controlled trial.

OBJECTIVES

The randomized controlled study explored whether physiological ischemia training (PIT) can inhibit ventricular remodeling and reduce ventricular arrhythmias in the early period of acute myocardial infarction (AMI).

METHODS

AMI patients with hypotension or bradycardia were randomly divided into PIT (n = 21) and control (n = 20) groups. Meanwhile, patients with normal blood pressure (BP) and heart rate (HR) were randomly divided into PIT+angiotensin-converting enzyme inhibitor (ACEI) and/or β-blocker (AB) (n = 30) and AB (n = 30) groups. PIT was performed in the PIT and PIT+AB groups. Finally, indicators of renin-angiotensin-aldosterone system (RAAS) activity, ventricular remodeling, cardiac function, vascular neovascularization, and ventricular arrhythmias were compared among the groups after 3 months of intervention.

RESULTS

Indicators of RAAS activity, ventricular remodeling, left ventricular ejection fraction (LVEF) and QT dispersion (QTd) were improved in the PIT, PIT+AB and AB groups after 3 months of intervention (P < 0.05). Improvements in the indicators of RAAS activity, ventricular remodeling, LVEF and QTd in the PIT+AB group were superior to those in the AB group by the end of training (P < 0.05). The levels of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in circulating blood were higher significantly in the PIT and PIT+AB groups after 3 months of intervention (P < 0.05). The Lown classification in the PIT+AB group decreased more than in other groups, and there was a significant difference compared with the control group (P < 0.05). Diastolic BP increased to some extent during PIT, whereas systolic BP or HR showed no significant effects.

CONCLUSIONS

These findings suggest that PIT can effectively inhibit early ventricular remodeling, thereby reducing the risk of ventricular arrhythmias after myocardial infarction, and patients can further benefit from a combination of PIT and ACEIs/angiotensin receptor blockers and beta-blockers.