LONG-TERM PHYSICAL-TRAINING AND LEFT-VENTRICULAR REMODELING AFTER ANTERIOR MYOCARDIAL-INFARCTION - RESULTS OF THE EXERCISE IN ANTERIOR MYOCARDIAL-INFARCTION (EAMI) TRIAL

Objectives. The aim of this multicenter randomized study was to invest igate whether long-term physical training would influence left ventric ular remodeling after anterior myocardial infarction. Background. Exer cise is currently recommended for patients after myocardial infarction ; however, the effects of long-term physical training on ventricular s ize and remodeling still have to be defined. Methods. Patients with no contraindications to exercise were studied 4 to 8 weeks after anterio r Q wave myocardial infarction and 6 months later by echocardiography at rest and bicycle ergometric testing. After the initial study, patie nts were randomly allocated to a 6-month exercise training program (n = 49) or a control group (n = 46). A computerized system was used to d erive echocardiographic variables of ventricular size, function and to pography. Results. After 6 months, a significant (p < 0.01) increase i n work capacity (from 4,596 +/- 1,246 to 5,508 +/- 1,335 kp-m) was obs erved only in the training group, whereas global ventricular size, reg ional dilation and shape distortion did not change in either the contr ol or the training group. However, compared with patients with an ejec tion fraction > 40%, patients with an ejection fraction less than or e qual to 40% had more significant (p < 0.001) ventricular enlargement a t entry and demonstrated further (p < 0.01) global and regional dilati on after 6 months, in both the control and the training group (end-dia stolic volume from 77 +/- 14 to 85 +/- 17 ml/m(2) in the control group and from 74 +/- 11 to 77 +/- 15 ml/m(2) in the training group; region al dilation from 46 +/- 18% to 57 +/- 21% in the control group and fro m 42 +/- 18% to 44 +/- 26% in the training group). Ventricular size an d topography did not change in patients with an ejection fraction > 40 %. Conclusions. Patients with poor left ventricular function 1 to 2 mo nths after anterior myocardial infarction are prone to further global and regional dilation. Exercise training does not appear to influence this spontaneous deterioration. Thus, postinfarction patients without clinical complications, even those with a large anterior infarction, m ay benefit from long-term physical training without any additional neg ative effect on ventricular size and topography.