A Randomized Comparison of Exercise Training in Patients With Normal vs Reduced Ventricular Function (original) (raw)
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Disability and Rehabilitation, 2014
Purpose: To assess whether the same exercise-based inpatient program applied to patients with normal and reduced left ventricular function (LVF) evokes a similar cardiac autonomic response after coronary artery bypass graft (CABG). Method: Forty-four patients post-CABG, subgrouped according to normal LVF [LVFN: n ¼ 23; left ventricular ejection fraction (LVEF) ! 55%] and reduced LVF (LVFR: n ¼ 21; LVEF 35-54%), were included. All initiated the exercise protocol on post-operative day 1 (PO1), following a whole progressive program until discharge. Cardiac autonomic response was assessed by the indices of heart rate variability (HRV) at rest and during exercise (extremity range of motion and ambulation). Results: During ambulation, lower values of HRV indices were found in the LVFR group compared with the LVFN group [standard deviation of all RR (STDRR; 6.1 AE 2.7 versus 8.9 AE 4.7 ms), baseline width of the RR histogram (TINN; 30.6 AE 14.8 versus 45.8 AE 24.9 ms), SD2 (14.8 AE 8.0 versus 21.3 AE 9.0 ms), Shannon entropy (3.6 AE 0.5 versus 3.9 AE 0.4) and correlation dimension (0.08 AE 0.2 versus 0.2 AE 0.2)]. Also, when comparing the ambulation to rest change, lower values were observed in the LVFR group for linear (STDRR, TINN, RR TRI, rMSSD) and non-linear (SD2 and correlation dimension) HRV indices (p50.05). On PO1, we observed only intra-group differences between rest and exercise (extremity range of motion), for mean intervals between heart beats and heart rate. Conclusion: For patients with LVFN, the same inpatient exercise protocol triggered a more attenuated autonomic response compared with patients with LVFR. These findings have implications as to how exercise should be prescribed according to LVF in the early stages following recovery from CABG.
Chest, 2001
Background: The time required for oxygen uptake (V O 2) to return to baseline level (recovery kinetics) is prolonged in patients with reduced ventricular function, and the degree to which it is prolonged is related to the severity of heart failure, markers of abnormal ventilation, and prognosis. In the present study, we sought to determine the effect of exercise training on V O 2 recovery kinetics in patients with reduced ventricular function. Methods: Twenty-four male patients with reduced ventricular function after a myocardial infarction were randomized to either a 2-month high-intensity residential exercise training program or to a control group. V O 2 kinetics in recovery from maximal exercise were calculated before and after the study period and expressed as the slope of a single exponential relation between V O 2 and time during the first 3 min of recovery. Results: Peak V O 2 increased significantly in the exercise group (19.4 ؎ 3.0 mL/kg/min vs 25.1 ؎ 4.7 mL/kg/min, p < 0.05), whereas no change was observed in control subjects. The V O 2 half-time in recovery was reduced slightly after the study period in both groups (108.7 ؎ 33.1 to 102.1 ؎ 50.5 s in the exercise group and 122.3 ؎ 68.7 to 107.5 ؎ 36.0 s in the control group); neither the change within or between groups was significant. The degree to which V O 2 was prolonged in recovery was inversely related to measures of exercise capacity (peak V O 2 , watts achieved, and exercise time; r ؍ ؊ 0.48 to ؊ 0.57; p < 0.01) and directly related to the peak ventilatory equivalents for oxygen (r ؍ 0.59, p < 0.01) and carbon dioxide (r ؍ 0.57, p < 0.01). Conclusion: Two months of high-intensity training did not result in a faster recovery of V O 2 in patients with reduced ventricular function. This suggests that adaptations to exercise training manifest themselves only during, but not in, recovery from exercise.
Journal of Research in Medical Sciences, 2012
BACKGROUND: Supervised exercise-based cardiac rehabilitation programs (CRP) have been suggested to all patients, especially after myocardial infarction. However, the effects of cardiac rehabilitation on systolic function are controversial. The aim of this study was to examine the effects of an 8-week cardiac rehabilitation on left ventricular systolic function and left ventricular mass in patients with myocardial infarction (MI) and revascularization. METHODS: This study included 29 men with MI after reperfusion therapy, i.e. coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The patients were randomized into a training group (n = 15, mean age: 54.2 ± 9.04 years) and a control group (n = 14, mean age: 51.71 ± 6.98 years). The training group performed 8 weeks of CRP with an intensity of 60-85% of maximum heart rate, 3 times a week. Each session lasted for 60 minutes. Before and at the end of the study, all patients underwent 2-dimentional echocardiography for left ventricular systolic function and left ventricular mass to be assessed. RESULTS: After 8 weeks of CRP, left ventricular ejection fraction (LVEF) increased significantly in the training group (48.53 ± 10.41 vs. 59.13 ± 5.90; p < 0.001). Moreover, the difference in LVEF between the training and control groups were significant after the course (59.13 ± 5.90 vs. 55.90 ± 9.60; p < 0.001). In addition, stroke volume increased significantly (57.22 ± 7.84 ml vs. 64.03 ± 12.80 ml; p < 0.001) while left ventricular systolic volume decreased significantly (42.89 ± 17.32 ml vs. 31.00 ± 8.34 ml; p < 0.001) in the training group. CRP was decreased left ventricular mass in the training group (229 ± 42 vs. 196 ± 34; p < 0.05). CONCLUSIONS: A 2-month CRP in post-MI patients led to improvements in systolic function and reductions in left ventricular mass and thus cardiomegaly.
Rehabilitation Nursing, 2014
Introduction. The accurate impact of exercise on coronary artery disease (CAD) patients with left ventricular dysfunction is still debatable. We studied the effects of cardiac rehabilitation (CR) on echocardiography parameters in CAD patients with ventricular dysfunction. Methods. Patients with CAD who had ventricular dysfunction were included into an exercise-based rehabilitation program and received rehabilitation for eight weeks. All subjects underwent echocardiography before and at the end of the rehabilitation program. The echocardiography parameters, including left ventricular ejection fraction (LVEF), LV enddiastolic (LVEDD) and end-systolic diameters (LVESD), and peak exercise capacity measured in metabolic equivalents (METs), were assessed. Results. Seventy patients (mean age = 57.5 ± 10.2 years, 77.1% males) were included into the study. At the end of rehabilitation period, the LVEF increased from 45.14 ± 5.77% to 50.44 ± 8.70% (< 0.001), and the peak exercise capacity increased from 8.00 ± 2.56 to 10.08 ± 3.00 METs (< 0.001). There was no significant change in LVEDD (54.63 ± 12.96 to 53.86 ± 8.95 mm, = 0.529) or in LVESD (38.91 ± 10.83 to 38.09 ± 9.04 mm, = 0.378) after rehabilitation. Conclusion. Exercise training in postmyocardial infarction patients with ventricular dysfunction could have beneficial effects on cardiac function without adversely affecting LV remodeling or causing serious cardiac complications. adversely affecting LV remodeling or causing serious cardiac complications. Further well-designed trials with longer follow-ups are required in this regard.
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.10\_Oct2021/IJRR-Abstract044.html, 2021
Background: Phase II cardiac rehabilitation is essential for management post coronary artery bypass graft (CABG), especially in patients with left ventricular systolic dysfunction. Change in functional capacity after phase II cardiac rehabilitation (∆METs) is an indicator of cardiopulmonary and hemodynamic improvement after CABG. This study assessed the correlation of ∆METs as a predictor of major adverse cardiac event (MACE) 3 months after CABG in patients with left ventricular systolic dysfunction. Methods: A cohort study was conducted on patients with left ventricular systolic dysfunction who underwent CABG between January 2019 to January 2021. Then patients were recruited to phase II cardiac rehabilitation, ∆METs was measured and tabulated by differences of functional capacity before and after the program. The abnormalities of ∆METs were discovered as a predictor of MACE determined by cutoff point, which is combination of death and rehospitalization. Patients were monitored for 3 months after CABG. Result: Among 91 patients, 24.2% had MACE (6.6% death and 17.6% rehospitalization). We found significant correlation between ∆METs and MACE with cutoff point 3.25 METs (p <0.001). Multivariate analysis using logistic regression showed lower ∆METs group had significant correlation with MACE (OR 0.135; p 0.03). Kaplan Meier survival analysis showed lower ∆METs group was predictor of MACE on 3 months after CABG, risk of MACE occurrence 3.9 times than higher ∆METs group (p <0.001). Conclusion: Change in functional capacity could predict MACE on 3 months follow-up of left ventricular systolic dysfunction patients who underwent CABG.
Aerobic Capacity in Patients Entering Cardiac Rehabilitation
Circulation, 2006
Background-Symptom-limited treadmill testing is commonly performed on entry to cardiac rehabilitation (CR) for its prognostic value and to design a safe and effective exercise program. Normative values for this evaluation are not available. The primary goals of this study were to establish normative values for peak aerobic capacity (peak V O 2 ) for patients entering CR and to create nomograms for conversion of peak V O 2 to a percentage of predicted exercise capacity, stratified by age, gender, and diagnosis.
Reviews in Cardiovascular Medicine
Background: Aerobic high-intensity interval training (HIIT) has demonstrated benefits for ventricular remodeling after myocardial infarction (MI) through various mechanisms. Despite this, the optimal training volume is not well known. The present study aimed to assess the effects of different (low vs. high volume) aerobic HIIT compared to an attentional control (AC) group on echocardiographic and biochemical indicators of left ventricular (LV) remodeling in adults after MI. Methods: Randomized clinical trial conducted on post-MI patients with preserved ventricular function. Participants were assigned to three study groups. Two groups performed HIIT 2 d/week, one group with low-volume HIIT (20 min, n = 28) and another with high-volume HIIT (40 min, n = 28). A third group was assigned to AC (n = 24) with recommendations for unsupervised aerobic training. Left ventricular echocardiographic parameters and cardiac biomarker levels (N-terminal pro-b-type natriuretic peptide, NT-proBNP; soluble growth stimulation expressed gene 2, ST2; troponin T; and creatine kinase) were assessed at baseline and after the intervention (16 weeks). Results: Eighty participants (58.4 ± 8.3 yrs, 82.5% male) were included. Both low-and high-volume HIIT showed increases (p < 0.05) in left ventricular end-diastolic diameter (1.2%, 2.6%), and volume (1.1%, 1.3%), respectively. Interventricular septal and posterior walls maintained their thickness (p = 0.36) concerning the AC. Significant (p < 0.05) gain in diastolic function was shown with the improvements in E (-2.1%,-3.3%), e' waves (2.2%, 5.5%), and the deceleration time (2.1%, 2.9%), and in systolic function with a reduction in global longitudinal strain (-3.2%,-4.7%), respectively. Significant (p < 0.05) reductions of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (-4.8%,-11.1%) and of ST2 (-21.7%,-16.7%)were found in both HIIT groups respectively compared to the AC group. Creatine kinase elevation was shown only in high-volume HIIT (19.3%, p < 0.01). Conclusions: Low-volume HIIT is proposed as a clinically time-efficient and safer strategy to attenuate dysfunctional remodeling by preventing wall thinning and improving LV function in post-MI patients.
Brazilian Journal of Medical and Biological Research, 2007
Patients with heart failure who have undergone partial left ventriculotomy improve resting left ventricular systolic function, but have limited functional capacity. We studied systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculotomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Nine patients with heart failure previously submitted to partial left ventriculotomy were compared with 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise test with measurement of peak oxygen uptake and anaerobic threshold. Radionuclide left ventriculography was performed to analyze ejection fraction and peak filling rate at rest and during exercise at the intensity corresponding to the anaerobic threshold. Groups presented similar exercise capacity evaluated by peak oxygen uptake and at anaerobic threshold. Maximal heart rate was lower in the partial ventriculotomy group compared to the heart failure group (119 ± 20 vs 149 ± 21 bpm; P < 0.05). Ejection fraction at rest was higher in the partial ventriculotomy group as compared to the heart failure group (41 ± 12 vs 32 ± 9%; P < 0.0125); however, ejection fraction increased from rest to anaerobic threshold only in the heart failure group (partial ventriculotomy = 44 ± 17%; P = nonsignificant vs rest; heart failure = 39 ± 11%; P < 0.0125 vs rest; P < 0.0125 vs change in the partial ventriculotomy group). Peak filling rate was similar at rest and increased similarly in both groups at the anaerobic threshold intensity (partial ventriculotomy = 2.28 ± 0.55 EDV/s; heart failure = 2.52 ± 1.07 EDV/s; P < 0.0125; P > 0.05 vs change in partial ventriculotomy group). The abnormal responses demonstrated here may contribute to the limited exercise capacity of patients with partial left ventriculotomy despite the improvement in resting left ventricular systolic function.
2012
Background Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG). However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV) function in a cohort of patients who underwent CABG. Methods: A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before su...