Barletta G A, Fattirolli F, Bisi G, Bertini G, Malfanti P L, Gallini C, Pedenovi P, Fantini F
Eur Heart J. 1983 Nov;4(11):761-72. doi: 10.1093/oxfordjournals.eurheartj.a061396.
Whether physical training, soon after myocardial infarction (MI), has effects upon intrinsic cardiac function at rest and during exertion remains unresolved. We have evaluated ventricular function using radionuclide angiography at rest and during stress testing before and after 3 months' physical training. This has been correlated with the site of MI and with changes in the ST segment during the maximal exercise test performed before the postmyocardial infarction rehabilitation program. We have studied 27 patients, mean age 54 +/- 10 years, in NYHA class I or II. Twelve showed no changes in the ST segment during erogmetric stress test (group 1); seven showed ST segment depression greater than 1 mm in leads different from those of MI (group 2); eight showed ST segment elevation of 2 mm (group 3). Twelve patients had had anterior MI only (AMI group); twelve inferior MI only (IMI group). After rehabilitation, all patients showed an increased work capacity and a decreased double product at the same work load. In the total group, significant increases were found in the left ventricular ejection fraction (LVEF) and in the contractile regional performance (LVwm) at rest, as well as a lesser decrease in the LVEF during handgrip test. Group 1 showed a significant increase in LVEF, associated with a decrease in left ventricular end-diastolic volume (EDV) at rest. Group 2 showed unchanged variables after rehabilitation. Group 3 showed a better LVEF during handgrip with an increase of EDV at rest. The AMI group showed a better LVEF and LVwm at rest and a better LVEF during handgrip. IMI group showed a better right ventricular ejection fraction during handgrip without improvement in LVEF. No patient with IMI had septal asynergy. We conclude that the effects of rehabilitation were linked to the site of MI and to the functional dynamic status of both ventricles.
心肌梗死（MI）后不久进行体育锻炼是否会对静息和运动时的心脏固有功能产生影响，目前尚无定论。我们在3个月体育锻炼前后，通过放射性核素血管造影术评估了静息和应激测试时的心室功能。这与心肌梗死的部位以及心肌梗死后康复计划前进行的最大运动测试期间ST段的变化相关。我们研究了27例患者，平均年龄54±10岁，纽约心脏协会（NYHA）心功能分级为I级或II级。12例患者在运动应激测试期间ST段无变化（第1组）；7例患者在与心肌梗死部位不同的导联中ST段压低大于1mm（第2组）；8例患者ST段抬高2mm（第3组）。12例患者仅发生前壁心肌梗死（前壁心肌梗死组）；12例患者仅发生下壁心肌梗死（下壁心肌梗死组）。康复后，所有患者在相同工作负荷下的工作能力均有所提高，双乘积降低。在整个研究组中，静息时左心室射血分数（LVEF）和收缩区域功能（LVwm）显著增加，以及在握力测试期间LVEF的降低幅度较小。第1组静息时LVEF显著增加，同时左心室舒张末期容积（EDV）降低。第2组康复后各项指标未发生变化。第3组在握力测试期间LVEF较好，静息时EDV增加。前壁心肌梗死组静息时LVEF和LVwm较好，握力测试期间LVEF也较好。下壁心肌梗死组在握力测试期间右心室射血分数较好，但LVEF无改善。下壁心肌梗死患者均无室间隔运动失调。我们得出结论，康复效果与心肌梗死部位以及双心室的功能动态状态有关。
