Influence of Physical Training after a Myocardial Infarction on Left Ventricular Contraction Mechanics

Lima, Márcio Silva Miguel; Dalçóquio, Talia Falcão; Abduch, Maria Cristina Donadio; Tsutsui, Jeane Mike; Mathias Jr, Wilson; Nicolau, José Carlos

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Arquivos Brasileiros de Cardiologia

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Original Article • Arq. Bras. Cardiol. 120 (4) • Mar 2023 • https://doi.org/10.36660/abc.20220185 copy

Influence of Physical Training after a Myocardial Infarction on Left Ventricular Contraction Mechanics

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Exercise plays a positive role in the course of the ischemic heart disease, enhancing functional capacity and preventing ventricular remodeling.

Objective

To investigate the impact of exercise on left ventricular (LV) contraction mechanics after an uncomplicated acute myocardial infarction (AMI).

Methods

A total of 53 patients was included, 27 of whom were randomized to a supervised training program (TRAINING group), and 26 to a CONTROL group, who received usual recommendations on physical exercise after AMI. All patients underwent cardiopulmonary stress testing and a speckle tracking echocardiography to measure several parameters of LV contraction mechanics at one month and five months after AMI. A p value < 0.05 was considered statistically significant for the comparisons of the variables.

Results

No significant difference were found in the analysis of LV longitudinal, radial and circumferential strain parameters between groups after the training period. After the training program, analysis of torsional mechanics demonstrated a reduction in the LV basal rotation in the TRAINING group in comparison to the CONTROL group (5.9±2.3 vs. 7.5±2.9^o; p=0.03), and in the basal rotational velocity (53.6±18.4 vs.68.8±22.1 º/s; p=0.01), twist velocity (127.4±32.2 vs. 149.9±35.9 º/s; p=0.02) and torsion (2.4±0.4 vs. 2.8±0.8 º/cm; p=0.02).

Conclusions

Physical activity did not cause a significant improvement in LV longitudinal, radial and circumferential deformation parameters. However, the exercise had a significant impact on the LV torsional mechanics, consisting of a reduction in basal rotation, twist velocity, torsion and torsional velocity which can be interpreted as a ventricular “torsion reserve” in this population.

Myocardial Infarction; Exercise; Left Ventricular Dysfunction

Variables	Control (n = 26)	Training (n = 27)	p
Demographics
Age, y	59±11	60±9	0.73
Gender M / F, n (%)	19 (73%) / 7 (27%)	20 (74%) / 7 (26%)	0.93
BMI, kg/m²	27.4±3.9	27.2±3.9	0.84
Hypertension, n (%)	17 (65%)	13 (48%)	0.21
Diabetes Mellitus, n (%)	10 (38%)	6 (22%)	0.84
Smoker, n (%)	5 (19%)	10 (37%)	0.15
Sedentarism, n (%)	26 (100%)	27 (100%)	1.00
Dyslipidemia	8 (31%)	9 (33%)	0.84
Previous AMI, n (%)	4 (15%)	3 (11%)	0.70
Treatment
Aspirin, n (%)	26 (100%)	27 (100%)	1.00
Clopidogrel, n (%)	24 (92%)	27 (100%)	0.24
Ticagrelor, n (%)	2 (8%)	0 (0%)	0.24
β-blocker, n (%)	17 (65%)	23 (85%)	0.09
ACEI/ARB	16 (61%)	21 (78%)	0.20
Event
STEMI, n (%)	14 (54%)	16 (59%)	0.51
NSTEMI, n (%)	12 (46%)	11 (41%)	0.69
Troponin, ng/mL (median, IQR)	22 (3-50)	32 (11-50)	0.35
Risk Scores
TIMI STEMI score	3.3±1.8	2.7±1.8	0.38
TIMI NSTEMI score	3.7±1.3	3.2±1.1	0.31
GRACE (median, IQR)	129 (120-159)	139 (121-151)	0.74
Treatment
Fibrinolysis, n (%)	4 (15%)	6 (22%)	0.73
Primary PTCA, n (%)	8 (31%)	8 (30%)	0.93
Pharmaco-invasive strategy, n (%)	3 (12%)	2 (7%)	0.66
BMS, n (%)	19 (73%)	23 (85%)	0.23
DES, n (%)	5 (19%)	1 (4%)	0.10

Variables	Control			Training

	Basal	4M	p*	Basal	4M	p*
Echocardiogram
LA, mm	37.3±3.7	36.6±3.4	0.02	38.7±3.4	38.8±3.3	0.63
LVEDD, mm	50.2±4.3	50.0±4.3	0.21	50.9±3.1	51.3±3.5	0.38
LVESD, mm	33.1±5.0	31.9±3.9	0.05	33.6±3.0	34.6±4.6	0.11
LVEDV, ml	99.9±23.2	99.5±23.5	0.66	94.3±15.2	92.2±16.4	0.40
LVESV, ml	39.6±11.1	42.0±10.2	0.11	42.3±11.5	42.6±9.1	0.85
LVMI. g/m²	90.7±18.6	89.7±18.0	0.28	92.7±16.7	92.2±16.4	0.88
LVEF, %	61.3±5.7	60.0±5.1	0.19	60.0±5.9	59.6±5.6	0.70
WMSI	1.19±0.19	1.16±0.19	0.19	1.18±0.16	1.17±0.18	0.39
E Vel, cm/s	81±24	81±22	0.89	74±0.18	74±18	0.95
e’ Vel cm/s	7.1±1.6	7.2±1.8	0.80	6.9±1.7	6.9±1.8	0.89
E/e’ ratio	12.1±5.3	11.8±4.6	0.65	11.5±3.9	11.6±4.9	0.92
E/A ratio	1.21±0.52	1.13±0.39	0.34	1.09±0.41	1.20±0.46	0.16
CPX
Exercise duration, secs	491±93‡	593±93	0.006	524±95‡	636±131	0.001
Basal HR, bpm	73±14	70±11	0.58	70±10	64±10	0.002
Max HR, bpm	133±22	134±15	0.84	127±19	128±19	0.78
Basal SBP, mmHg	124±11	119±14	0.35	120±18	117±14	0.51
Peak SBP, mmHg	169±18†	176±16	0.41	184±27†	178±18	0.41
Maximal exercise workload, W	109±43	119±48	0.11	126±49	151±65	0.007
Peak VO₂, ml/kg/min	20.6±4.6	21.7±4.9	0.12	21.7±5.2	23.4±5.9	0.04
AT, ml/kg/min	12.3±2.3	13.7±2.4	0.08	12.3±3.2	14.3±3.4	0.11
VE, L/min	59.5±21.3	59.4±19.5	0.97	62.7±18.7	69.2±20.4	0.93

Variables	Control			Training

	Basal	4 months	p*	Basal	4 months	p*
APLAX
LS, %	17.5 ± 3.3	18.6 ± 2.5	0.09	17.6 ± 2.0	17.8 ± 2.8	0.54
LSR, 1/s	0.98 ± 0.16	1.04 ± 0.20	0.08	0.97 ± 0.15	0.95 ± 0.20	0.65
A4C
LS, %	18.5 ± 3.3	18.6 ± 2.8	0.91	17.9 ± 2.7	17.8 ± 3.3	0.89
LSR, 1/s	1.01 ± 0.23	1.00 ± 0.20	0.98	0.93 ± 0.16	0.90 ± 0.21	0.44
A2C
LS, %	18.7 ± 2.9	18.4 ± 2.7	0.36	19.4 ± 2.8	18.4 ± 3.4	0.06
LSR, 1/s	1.04 ± 0.21	1.01 ± 0.15	0.24	1.03 ± 0.17	0.92 ± 0.18	0.01
GLOBAL
LS, %	18.3 ± 2.7	18.5 ± 2.5	0.55	18.3 ± 2.2	18.0 ± 2.9	0.48
LSR, 1/s	1.00 ± 0.18	1.02 ± 0.17	0.67	0.98 ± 0.14	0.92 ± 0.18	0.14

	Control			Training

	Basal	4 months	p*	Basal	4 months	p*
PSAX – Basal
CS, %	17.0 ± 3.9	18.0 ± 3.1	0.11	16.6 ± 2.6	16.1 ± 3.4	0.38
RS, %	39.7 ± 21.0	34.3 ± 17.9	0.13	34.8 ± 13.9	31.8 ± 15.7	0.41
CSR, 1/s	1.54 ± 0.40	1.62 ± 0.36	0.42	1.52 ± 0.36	1.47 ± 0.31	0.58
RSR, 1/s	2.32 ± 0.92	2.41 ± 0.83€	0.68	2.20 ± 0.71	1.87 ± 0.71€	0.03
Rot,^o	-6.7 ± 3.2	-7.5 ± 2.9†	0.18	-6.7 ± 2.9	-5.9 ± 2.3†	0.15
Rot vel,^o/s	-66.6 ± 17.9	-68.8 ± 22.1‡	0.10	-57.8 ± 13.8	-53.6 ± 18.4‡	0.32
PSAX – Mid
CS, %	15.8 ± 4.1	16.3 ± 3.6	0.55	15.9 ± 3.2	16.1 ± 3.8	0.71
RS, %	34.4 ± 19.3	39.4 ± 18.0	0.24	34.4 ± 11.9	35.6 ± 18.3	0.75
CSR, 1/s	1.44 ± 0.25	1.43 ± 0.26	0.75	1.43 ± 0.25	1.41 ± 0.31	0.48
RSR, 1/s	2.10 ± 0.84	2.31 ± 1.11	0.23	1.95 ± 0.58	2.16 ± 0.89	0.87
PSAX – Apex
CS, %	19.3 ± 4.8	18.0 ± 3.9	0.16	20.5 ± 5.9	19.7 ± 5.8	0.62
RS, %	23.9 ± 9.0	19.1 ± 8.2	0.19	22.5 ± 7.7	25.0 ± 11.9	0.43
CSR, 1/s	1.53 ± 0.40	1.48 ± 0.42	0.67	1.56 ± 0.38	1.36 ± 0.39	0.09
RSR, 1/s	1.89 ± 0.97	1.80 ± 0.91	0.77	1.73 ± 1.18	1.90 ± 1.32	0.52
Rot,^o	15.5 ± 6.5	15.5 ± 5.0	0.95	14.9 ± 5.6	14.6 ± 4.1	0.74
Rot vel,^o/s	84.9 ± 26.8	81.1 ± 23.2	0.43	78.0 ± 21.7	73.8 ± 18.7	0.38
GLOBAL
CS, %	17.4 ± 3.5	17.4 ± 2.6	0.95	17.7 ± 3.1	17.3 ± 3.6	0.62
RS, %	30.8 ± 12.7	30.7 ± 8.5	0.94	29.5 ± 8.8	30.1 ± 12.7	0.78
CSR, 1/s	1.51 ± 0.27	1.51 ± 0.21	0.97	1.51 ± 0.26	1.41 ± 0.27	0.21
RSR, 1/s	2.10 ± 0.58	2.17 ± 0.52	0.57	1.96 ± 0.47	1.98 ± 0.74	0.92
TORSION
Twist , ^o	22.2 ± 7.1	23.1 ± 6.0	0.46	21.6 ± 6.2	20.5 ± 3.9	0.41
Tw vel,^o/s	145.5 ± 32.3	149.9 ± 35.9¥	0.53	135.8 ± 28.3	127.4 ± 32.2¥	0.28
Torsion,^o/cm	2.6 ± 0.8	2.8 ± 0.8£	0.18	2.6 ± 0.7	2.4 ± 0.4£	0.27
T vel,^o/s.cm	17.4 ± 3.9	18.5 ± 5.2	0.22	16.3 ± 3.6	15.0 ± 3.6	0.17

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[1] Mailing Address: Márcio Silva Miguel Lima • Unidade Clinica de Coronariopatia Aguda, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – Av. Dr. Enéas de Carvalho Aguiar, 44. Postal Code 05.403-000, Cerqueira Cesar, São Paulo, SP – Brazil E-mail: marcio.lima@incor.usp.br