Can cardiac rehabilitation programs improve functional capacity and left ventricular diastolic function in patients with mechanical reperfusion after ST elevation myocardial infarction?: A double-blind clinical trial.
BACKGROUND
Current guidelines recommend cardiac rehabilitation programs (CRP) as a means to improve functional status of patients after coronary revascularization. However, research supporting this recommendation has been limited and positive effects of CRP on diastolic function are controversial. The aim of this study was to examine the effects of an 8-week CRP on left ventricular diastolic function.


METHODS
This randomized, clinical trial included 29 men with ST elevation myocardial infarction (MI) who had received reperfusion therapy, i.e. coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). They were randomized to a training group (n = 15; mean age: 54.2 ± 9.04 years old) and a control group (n = 14; mean age: 51.71 ± 6.98 years old). Patients in the training group performed an 8-week CRP with an intensity of 60-85% of maximum heart rate. Exercise sessions lasted 60-90 minutes and were held three times a week. At the start and end of the study, all patients performed symptom-limited exercise test based on Naughton treadmill protocol. Pulsed-wave Doppler echocardiography was also used to determine peak velocity of early (E) and late (A) waves, E/A ratios, and the deceleration time of E (DT).


RESULTS
Left ventricular diastolic indices (E, A, E/A ratio, DT) did not change significantly after the CRP. Compared to baseline, patients in the training group had significant improvements in functional capacity (8.30 ± 1.30 vs. 9.7 ± 1.7) and maximum heart rate (118.50 ± 24.48 vs. 126.85 ± 22.75). Moreover, resting heart rate of the training group was significantly better than the control group at the end of the study (75.36 ± 7.94 vs. 79.80 ± 7.67; P < 0.001).


CONCLUSIONS
An 8-week CRP in post-MI patients revascularized with PCI or CABG led to improved exercise capacity. However, the CRP failed to enhance diastolic function.
Cardiologist, Fellowship of Interventional Electrophysiology, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran And Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Allahyar
A
Golabchi
Fatemeh
F
Basati
Mehdi
M
Kargarfard
Masoumeh
M
Sadeghi
Cardiac Rehabilitation; Diastolic Function; Functional Capacity; Post-Myocardial Patients