title: Physical training improves myocardial perfusion but not left ventricular function response to exercise in patients with microvascular angina.
abstract: BACKGROUND
  Patients with primary microvascular angina (PMA) commonly exhibit abnormal left ventricular function (LVF) during exercise, potentially owing to myocardial ischemia. Herein, we investigated in PMA patients the effect of the reduction of myocardial perfusion disorders, by using aerobic physical training, upon LVF response to exercise.
  
  
  METHODS
  Overall, 15 patients (mean age, 53.7±8.9 years) with PMA and 15 healthy controls (mean age, 51.0±9.4 years) were studied. All subjects were subjected to baseline resting and exercise ventriculography, myocardial perfusion scintigraphy (MPS), and cardiopulmonary testing. PMA group members then participated in a 4-month physical training program and were reevaluated via the same methods applied at baseline.
  
  
  RESULTS
  Baseline left ventricular ejection fraction (LVEF) determinations by ventriculography were similar for both groups (PMA, 67.7±10.2%; controls, 66.5±5.4%; P=0.67). However, a significant rise in LVEF seen in control subjects during exercise (75.3±6.2%; P=0.0001) did not materialize during peak exercise in patients with PMA (67.7±10.2%; P=0.47). Of the 12 patients in the PMA group who completed the training program, 10 showed a significant reduction in reversible perfusion defects during MPS. Nevertheless, LVEF at rest (63.5±8.7%) and at peak exercise (67.3±15.9%) did not differ significantly (P=0.30) in this subset.
  
  
  CONCLUSIONS
  In patients with PMA, reduced left ventricular inotropic reserve observed during exercise did not normalize after improving myocardial perfusion through aerobic physical training.
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo E
authors.initials: EE
authors.lastname: Carvalho
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Júlio C
authors.initials: JC
authors.lastname: Crescêncio
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Giovani L
authors.initials: GL
authors.lastname: Santi
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Oliveira
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Pedro V
authors.initials: PV
authors.lastname: Schwartzmann
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: Lourenço
authors.initials: L
authors.lastname: Gallo-Junior
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: José A
authors.initials: JA
authors.lastname: Marin-Neto
authors.affiliation: Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil - msimoes@fmrp.usp.br.
authors.forename: Marcus V
authors.initials: MV
authors.lastname: Simões
mesh_terms: D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015635:Radionuclide Ventriculography; D012189:Retrospective Studies; D016277:Ventricular Function, Left