EXERCISE TRAINING AND HEPARIN PRETREATMENT IN PATIENTS WITH CORONARY-ARTERY DISEASE

The purpose of this study was to evaluate whether combined treatment w ith a cardiovascular exercise rehabilitation program and low doses of heparin can induce changes in ergometric parameters of ischemia in pat ients with coronary artery disease (CAD). Heparin may potentiate the d evelopment of new vessels promoted by ischemia and therefore may produ ce important clinical improvement. Thirty-six patients with stable CAD and evidence of myocardial ischemia on exercise testing were randomiz ed into three groups: a control group (n = 11) received the usual medi cal treatment; another group (n = 11) underwent three exercise session s per week during 12 weeks; and a third group (n = 14) undertook this exercise program and also received calcium heparin 12,500 IU subcutane ously 20 to 30 minutes before each exercise session. Pretreatment and posttreatment exercise tests were compared. Patients who underwent the rehabilitation program had an increase in exercise duration and workl oad at the onset of 1 mm ST-segment depression, but only patients who received calcium heparin showed a significant increase in rate-pressur e product at the ST-segment ischemic threshold (p = 0.035). This resul t suggests that higher levels of myocardial oxygen consumption were no w tolerated, a change that may be related to an improvement in myocard ial perfusion.