Open AccessPatients with large myocardial infarction gain a greater improvement in exercise capacity after exercise training than those with small to medium infarction
Author(s) -
Sakuragi Satoru,
Takagi Shuichi,
Suzuki Shoji,
Sakamaki Fumio,
Takaki Hiroshi,
Aihara Naohiko,
Yasumura Yoshio,
Goto Yoichi
Publication year - 2003
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4950260608
Subject(s) - medicine , myocardial infarction , infarction , cardiology , rehabilitation , creatine kinase , physical therapy , heart rate , physical exercise , ventilation (architecture) , blood pressure , mechanical engineering , engineering
Background : It remains unclear whether patients with large‐size myocardial infarction (MI) achieve the same benefit from exercise training as do those with small‐ to medium‐size MI. Hypothesis : This study was designed to determine the magnitude and mechanisms underlying improvement in exercise capacity in patients with large‐size MI after cardiac rehabilitation. Methods : In all, 296 patients who participated in a cardiac rehabilitation program after acute MI were divided into two groups according to the peak serum creatine phosphokinase (CPK) level: the group with large infarction (Group 1) (≥ 5000 U/l peak CPK, 64 patients) and the group with less extensive infarction (Group 2) (< 5000 U/l, 232 patients). Exercise capacity was assessed before and after a 3‐month cardiac rehabilitation program that included exercise training. Results : Before exercise training, both the peak work rate (p < 0.05) and peak oxygen uptake (VO 2 ) (p < 0.01) were significantly lower in Group 1 than in Group 2. After exercise training, the changes in peak work rate and peak VO 2 were significantly greater in Group 1 than in Group 2 (both p < 0.01). The infarction size measured by the peak CPK level correlated significantly with both the baseline exercise capacity and its improvement after exercise training, although these correlations were insignificant in a multivariate analysis. In the multivariate analysis, the improvement in exercise capacity is determined by age and baseline exercise capacity, which is determined by the duration of inactivity, minute ventilation (VE)/ VCO 2 slope and left ventricular end‐diastolic pressure. Conclusions : Compared with patients with small‐ to medium‐size myocardial infarction, patients with large infarction gain a greater improvement in exercise capacity after exercise training due to reversal of physical deconditioning and improvement in congestive heart failure.