Improvement in ventricular function during exercise studied with radionuclide ventriculography after cardiac rehabilitation

Jensen, David G.; Atwood, J. Edwin; Froelicher, Victor F.; McKirnan, M. Dan; Battler, Alexander; Ashburn, William L.; Ross, John

doi:10.1016/0002-9149(80)90427-0

Cited by 54 publications

(14 citation statements)

References 36 publications

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“…13 before and 0.56 ± 0.16 after training). There are several differences between the study by Jensen et al 34 and the present study. In their study, 13 of the 19 patients had had a myocardial infarction, but in nine patients, the infarction occurred more than 6 months before training; measurements were made during supine exercise.…”

Section: Discussioncontrasting

confidence: 83%

Effects of exercise training on ventricular function in patients with recent myocardial infarction.

Cobb¹,

Williams²,

McEwan³

et al. 1982

Circulation

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SUMMARY We evaluated the effects of 6 months of exercise training (bicycle ergometry, walking and jogging) on exercise performance and ventricular function in patients with recent myocardial infarction. Fifteen patients were selected on the basis of myocardial infarction at least 6 weeks but not more than 6 months before the study and age younger than 65 years. The patients were evaluated by maximal treadmill exercise testing and radionuclide angiography at rest and exercise before and after training.Before exercise training, maximal treadmill exercise time ranged from 1.5 to 11 minutes, ejection fraction at rest from 18% to 67% and end-diastolic volume from 108 to 208 ml. The mean EF was 48 ± 5% (± SD) at rest and did not change at maximal exercise (48.5 ± 5%). All 11 patients who completed the exercise training program achieved a significant training effect, as defined by a reduction in heart rate at 50% maximal pretraining effort or an increase in maximal treadmill time. The mean ejection fraction and end-diastolic volume and wall motion abnormalities at rest and at comparable pretraining exercise work loads and heart rates were not significantly different after training.Despite a wide range of rest and exercise ventricular function, patients with recent uncomplicated myocardial infarcts significantly increased their exercise performance. Because rest and exercise ventricular function were comparable before and after training, improvement in exercise performance probably resulted from training effects on the peripheral vasculature.PATIENTS with coronary artery disease demonstrate a wide range of impaired cardiovascular adjustments during exercise.' Although exercise performance in certain patients with coronary artery disease may not be different from that in age-matched normal subjects, most patients have lower maximal cardiac output and maximal oxygen consumption,lA a decreased heart rate response to exercise and a decreased stroke volume at submaximal work loads. 1-' During mild supine exercise, left ventricular filling pressures are often elevated$'0 and systolic ejection rate and the rate of rise of pressure at a given ventricular pressure are reduced."1-3 Noninvasive evaluation of ventricular function using radionuclide angiography has shown that the left ventricular ejection fraction frequently decreases and regional wall motion abnormalities appear during exercise in patients with coronary disease.I-'7 These findings indicate that left ventricular dysfunction commonly occurs in patients with coronary artery disease during exercise stress.Exercise training improves exercise tolerance in most patients with coronary disease.2' 5, 18-22 Clausen' summarized the central and peripheral effects of exercise training and pointed out that the effects are qualitatively similar in subjects with and without coronary artery disease. In patients with coronary disease and no chest pain, training may improve maximal exercise

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Section: Discussioncontrasting

confidence: 83%

Effects of exercise training on ventricular function in patients with recent myocardial infarction.

Cobb¹,

Williams²,

McEwan³

et al. 1982

Circulation

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show abstract

“…A beneficial response to exercise was found by Letac et al [11], Conn et al [20], Verani et al [21], Leeet al [22], Jensen et al [23], Williams et al [24], Nagle and Murray [25], Tavazzi et al [17], Sullivan et al [26], Ehsani et al [27], and others [ 10]. In some of these studies [23] improvements of left ven tricular function were observed after a train ing period of 6-12 months.…”

Section: Lack O F Correlation and Training Effectmentioning

confidence: 89%

Arm Exercise Training in the Rehabilitation of Patients with Impaired Ventricular Function and Heart Failure

Kellermann¹,

Shemesh²,

Fisman³

et al. 1990

Cardiology

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Although exercise training is an accepted part of comprehensive coronary care programs in patients with coronary artery disease, it still remains to be demonstrated whether or not exercise training should also be applied to patients with impaired ventricular function. Circumstantial evidence exists that patients with impaired ventricular function may eventually benefit from an individually adapted exercise training program provided that contraindications for acceptance of cardiac patients to such a program are well observed. Our study is based on 22 patients with impaired ventricular function, of which 18 were at least 6 months after a Q-wave myocardial infarction and the remaining 4 after coronary artery bypass grafting. Eleven patients with impaired left ventricular function performing upper extremity (arm) ergometry were followed up for 36 months. These patients were trained twice weekly with exercise periods of 30 min duration. The reason for choosing arm ergometry training was that the peak heart rate obtained in arm ergometry is higher when compared to leg ergometry. Rate-pressure product and heart rate were higher for given submaximal work tasks in arm ergometry, while maximal work aerobic capacity was found to be lower in comparison to leg work. The assessment of our patients was based on cardiopulmonary testing, continuous electrocardiographic monitoring (48 h), two-dimensional echocardiography and equilibrium multigated radionuclide ventriculography (^99mTc). Group 1, consisting of 11 patients with left ventricular ejection fraction (LVEF) 30.1 ± 9.5%, were trained by arm exercise for 3 years with a significant increase in work capacity and LVEF. Group 2 consisted of 11 patients with LVEF 25.5 ± 6.8% who underwent a 12 months’ calisthenic program. Peak work capacity and LVEF remained unchanged. No patient developed heart failure during follow-up. We conclude that our results may indicate that a supervised arm training program in coronary patients with significant impairment of ventricular function may prove justified, provided that necessary percautions are observed.

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“…It is likely that HDL was prevented from rising above control levels by the altered dietary composition. A [31][32][33] Since coronary artery disease may progress considerably within an observation period, recruitment of a comparable control group was essential in this study. These patients probably received closer medical attention than regular patients not participating in a study; this assumption is supported by the fact that TGs decreased significantly in this group, which was probably secondary to repeated dietary advice.…”

Section: Methodsmentioning

confidence: 99%

Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia.

et al. 1988

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The effects of physical exercise and normalization of serum lipoproteins on stressinduced myocardial ischemia were studied in 18 patients with coronary artery disease, stable angina pectoris, and mild hypercholesterolemia (total serum cholesterol 242 + 32 mg/dl). These patients underwent a combined regimen of low-fat/low-cholesterol diet and regular, supervised physical exercise at high intensity for 12 months.

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Improvement in ventricular function during exercise studied with radionuclide ventriculography after cardiac rehabilitation

Cited by 54 publications

References 36 publications

Effects of exercise training on ventricular function in patients with recent myocardial infarction.

Effects of exercise training on ventricular function in patients with recent myocardial infarction.

Arm Exercise Training in the Rehabilitation of Patients with Impaired Ventricular Function and Heart Failure

Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia.

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