Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Tashiro, Hiroshi; Tanaka, Akihito; Ishii, Hideki; Motomura, N; Arai, Kenji; Adachi, Takeshi; Okajima, Takashi; Iwakawa, Naoki; Kojima, Hiroki; Mitsuda, Takayuki; Hirayama, Kenshi; Hitora, Yusuke; Hayashi, Michihiro; Fukui, Kenji; Yoshida, Ruka; Imai, Hisao; Ogawa, Yasuhiro; Kawaguchi, Katsuhiro; Murohara, Toyoaki

doi:10.1007/s00380-020-01576-2

Cited by 17 publications

(29 citation statements)

References 23 publications

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“…Patients after acute myocardial infarction (AMI) entering cardiac rehabilitation (CR) often have a low exercise capacity (EC) and it is well established that a low EC is strongly associated with a poor prognosis [1][2][3][4]. In The Henry Ford Exercise Testing (FIT) Project, in patients with known coronary artery disease, EC was a strong predictor of mortality, myocardial infarction, and downstream revascularizations.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Smarż

Jaxa-Chamiec

Zaborska

et al. 2021

JCM

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Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO2) ≥1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO2Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥40%, 73% improved their EC. In responders, peak VO2 improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO2. In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO2Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise.

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Section: Introductionmentioning

confidence: 99%

Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Smarż

Jaxa-Chamiec

Zaborska

et al. 2021

JCM

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“…Reduced exercise capacity after primary percutaneous coronary intervention in acute myocardial infarction patients may lead to worse clinical outcomes [1]. A major issue for rehabilitation in people with restricted movement is how to suppress skeletal muscle atrophy and the decreases in motor function [2,3].…”

Section: Introductionmentioning

confidence: 99%

Effects of whole-body neuromuscular electrical stimulation device on hemodynamics, arrhythmia, and sublingual microcirculation

et al. 2021

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Neuromuscular electrical stimulation has been used to treat cardiovascular diseases and other types of muscular dysfunction. A novel whole-body neuromuscular electrical stimulation (WB-NMES) wearable device may be beneficial when combined with voluntary exercises. This study aimed to investigate the safety and effects of the WB-NMES on hemodynamics, arrhythmia, and sublingual microcirculation. The study included 19 healthy Japanese volunteers, aged 22–33 years, who were not using any medication. Electrocardiogram (ECG), echocardiography, and blood sampling were conducted before a 20-min WB-NMES session and at 0 and 10 min after termination of WB-NMES. Their tolerable maximum intensity was recorded using numeric rating scale. Arrhythmia was not detected during neuromuscular electrical stimulation or during 10 min of recovery. Blood pressure, heart rate, left ventricular ejection fraction, and diastolic function remained unchanged; however, mild mitral regurgitation was transiently observed during WB-NMES in a single male participant. A decrease in blood glucose and an increase in blood lactate levels were observed, but no changes in blood fluidity, sublingual microcirculation, blood levels of noradrenaline, or oxidative stress were shown. WB-NMES is safe and effective for decreasing blood glucose and increasing blood lactate levels without changing the blood fluidity or microcirculation in healthy people.

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“…In fact, the introduction of a quarantine due to COVID-19 had a detrimental effect on the level of habitual physical activity performed by heart failure patients [8]. Reduced physical activity significantly lowers peak oxygen uptake (VO 2 ) [9], which is the gold standard indicator of cardiorespiratory fitness, and its decrease indicates a poor prognosis in patients with CVD [10,11]. As well, the effects of COVID-19, such as weight gain, also increase the risk of heart disease [12].…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on phase 2 cardiac rehabilitation patients in Japan

et al. 2021

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This study aimed to clarify the effects of the interruption of cardiac rehabilitation (CR) and refraining from going outside due to the COVID-19 pandemic on hemodynamic response and rating of perceived exertion (RPE) during exercise including differences by age in phase 2 CR outpatients. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the < 75 years group and ≥ 75 years group. Fiftythree patients were enrolled in the final analysis. Post-CR interruption, peak heart rate increased significantly (p = 0.009) in the < 75 years group, whereas in the ≥ 75 years group, weight and body mass index decreased significantly (p = 0.009, 0.011, respectively) and Borg scale scores for both dyspnea and lower extremities fatigue worsened significantly (both, p < 0.001). CR interruption and refraining from going outside due to the COVID-19 pandemic affected the hemodynamic response, RPE during exercise and body weight in phase 2 CR outpatients. In particular, patients aged ≥ 75 years appeared to be placed at an increased risk of frailty.

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Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Cited by 17 publications

References 23 publications

Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Effects of whole-body neuromuscular electrical stimulation device on hemodynamics, arrhythmia, and sublingual microcirculation

Impact of the COVID-19 pandemic on phase 2 cardiac rehabilitation patients in Japan

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