Ag. Digenio et al., Effect of myocardial ischaemia on left ventricular function and adaptability to exercise training, MED SCI SPT, 31(8), 1999, pp. 1094-1101
Purpose: We evaluated the possible interaction between exercise-induced myo
cardial ischemia and abnormalities in left ventricular function in 72 patie
nts with coronary artery disease at entry and upon discharge from a 6-month
exercise training program. Methods: Twenty-two patients with myocardial is
chemia (MIS) defined by electrocardiographic and radionuclide imaging crite
ria constituted our experimental group (EG). Fifty patients without MIS wer
e assigned to the control group for exercise training (CG-ET) and 31 health
y subjects to the control group for measures of left ventricular function (
CG-LV). Results: Both groups EG and CG-ET showed significant and comparable
increases in peak oxygen uptake (EG: 25.2 +/- 5.1 to 26.9 +/- 5.4 mL.kg(-1
).min(-1), P < 0.02; CG-ET: 25.1 +/- 0.6 to 27.4 +/- 0.7 mL.kg(-1).min(-1),
P < 0.001) after exercise training, but only CG-ET showed significant redu
ctions in heart rate, systolic blood pressure, and rate-pressure product du
ring submaximal exercise. A significant increase in end-diastolic volume co
ntributed to the increase in cardiac output during exercise in patients wit
h MIS. Heart rate or treadmill time at onset of ST segment depression faile
d to increase as a result of training, and stroke counts and the product of
stroke counts and heart rate showed a trend toward a decrease in response
to exercise, suggesting progression of disease. Conclusions: Patients with
myocardial ischemia showed improvements in maximal exercise capacity but fa
iled to elicit physiologic adaptations during submaximal exercise or to inc
rease the threshold for ischemia after exercise training. It is possible th
at the main emphasis in the management of this type of patient in a cardiac
rehabilitation setting should be placed more on coronary risk factor modif
ication to slow progression of disease than on improving cardiovascular eff
iciency.