Favourable effects of exercise-based Cardiac Rehabilitation after acute myocardial infarction on left atrial remodeling

• Published in: International journal of cardiology 2009-08, Vol.136 (3), p.300-306
• Main Authors: Giallauria, Francesco, Galizia, Gianluigi, Lucci, Rosa, D'Agostino, Mariantonietta, Vitelli, Alessandra, Maresca, Luigi, Orio, Francesco, Vigorito, Carlo
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Biological and medical sciences; Cardiac rehabilitation; Cardiology. Vascular system; Cardiomegaly - diagnostic imaging; Cardiomegaly - rehabilitation; Cardiopulmonary exercise test; Cardiopulmonary functional capacity; Cardiovascular; Coronary heart disease; Echocardiography, Doppler; Exercise Therapy; Exercise training; Female; Heart; Heart Atria - diagnostic imaging; Humans; Left atrial remodeling; Left ventricular remodeling; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - rehabilitation; Myocarditis. Cardiomyopathies; Prospective Studies; Rehabilitation - methods; Stroke Volume; Treatment Outcome; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - rehabilitation
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2008.05.026

Abstract Background Left atrial enlargement is an important predictor of cardiovascular outcomes in patients after acute myocardial infarction. While the favourable effect of exercise exercise-based Cardiac Rehabilitation (CR) on postinfarction LV remodeling has been well documented, those on LA remodeling have yet to be defined. This study investigated the effects of CR on LA remodeling in postinfarction patients with moderate left ventricular (LV) dysfunction. Methods Sixty postinfarction patients were randomised randomized into two groups, each composed of 30 patients: group T (LV ejection fraction (EF) 43.7 ± 4.2%, mean ± SD) entered a 6-month CR program, whereas group C (EF 44.7 ± 4.4%, P = ns) did not. Doppler echocardiography and cardiopulmonary exercise test were performed upon enrolment and at 6-month. Results At 6-month, trained patients showed a significant ( P < 0.001) improvement in peak oxygen consumption (ΔVO2peak = + 5.2 ± 2.1 ml/kg/min) and a reduction in LA (ΔLA VMAX = − 1.9 ± 3.7 ml/m2 ) and in LV volumes (ΔLVEDV = − 3.6 ± 4.4 ml/m2 ). At 6-month, untrained patients showed LA VMAX (+ 3.6 ± 4.4 ml/m2 , P < 0.001) and LV dilation (+ 4.2 ± 5.1 ml/m2 , P < 0.001; group T vs. C, P < 0.001); whereas no significant changes in VO2peak were observed. Multiple linear regression analysis showed that age ( β = 0.442, P < 0.001), inclusion in the training group ( β = − 0.599, P < 0.001), E/A ratio ( β = − 0.210, P = 0.038), LVEDV ( β = 0.376, P < 0.001), and LVEF ( β = − 0.279, P = 0.007) are significant predictors of LA remodeling. Conclusions Six-month exercise-based CR in postinfarction patients with mild to moderate LV dysfunction induced a favourable LA remodeling.