Cor Vasa 2005, 46(4)

Left ventricular remodeling in acute myocardial infarction after an outpatient controlled rehabilitation program.

Lubomír Elbl^1,*, Václav Chaloupka¹, Iva Tomášková¹, František Jedlička¹, Svatopluk Nehyba¹, Petr Kala², Jiří Schildberger², Martin Poloczek², Otakar Boček², Jindřich Špinar²

¹ Oddělení funkčního vyšetřování

² Interní kardiologická klinika, Fakultní nemocnice Brno-Bohunice, Brno, Česká republika

Aim of study:
The study reports on prospective one-year follow-up and analysis of the process of left ventricular remodeling in patients with their first acute myocardial infarction undergoing an early outpatient 8-week rehabilitation program.

Patients and methods:
Follow-up included a total of 184 patients (21 women, 163 men) aged 58 ± 9 years. An ejection fraction (EF) < 50 % was shown in 36 (20%) patients. Patients were divided into two subgroups: with anterior wall myocardial infarction (AWMI) (n = 63) and inferior wall myocardial infarction (PWMI) (n = 121). Resting and dynamic exercise echocardiography and spiroergometry were performed prior to rehabilitation, at its completion and 12 months later. Parameters assessed included resting and exercise EF, left ventricular (LV) volume, LV wall motion index (LVWMI) and peak oxygen intake (pVO2).

Results:
Following rehabilitation, both subgroups of patients showed significant increases in pVO2 and exercise tolerance (p < 0.0001), maintained as late as one year later. Prior to rehabilitation, patients with AWMI had significantly lower LVEF values (p < 0.05) and higher LVWMI (p < 0.01) than, while not differing in end-diastolic volume (EDV) compared with the PWMI subgroup. Rehabilitation was followed by EF improvement in both subgroups; the difference was maintained (p < 0.006) and persisted at one year (p < 0.002). Improvement was likewise seen in LVWMI, with the difference maintained between the subgroups both after rehabilitation (p < 0.03) and at one-year follow-up (p < 0.05). Both subgroups showed a significance decrease in EDV after rehabilitation (p < 0.0001). At one-year follow-up, EDV returned to baseline in patients with PWMI, being significantly higher (p < 0.05) compared with values seen in the other subgroup.

Conclusion:
An early outpatient controlled rehabilitation program did not have an adverse effect on the process of left ventricular remodeling both in the short run (8-week program) and in the long run (one-year follow-up).

Keywords: Acute myocardial infarction; Early rehabilitation; Left ventricular remodeling

Published: April 1, 2005  Show citation