Effects of a short-term training programme in post-infarct patients with residual myocardial ischaemia

To study prospectively haemodynamic changes after a four-week period of physical training in post-infarct patients with exercise-induced myocardial ischaemia, a maximal symptom-limited ergometric test in the supine position with electrocardiographic and haemodynamic monitoring was carried out in 46 males (mean age: 53 +/- 8 years) during drug wash-out 35 +/- 15 days after acute myocardial infarction (E1), and again after 31 +/- 3 days of physical training (E2). The infarction site was inferior in 38 patients (83%), anterior in seven (15%) and anterior + inferior in one (2%). After physical training none of the resting parameters were significantly changed. During exercise, working capacity increased from 6525 +/- 3314 to 8853 +/- 4342 kpm (P less than 0.001) together with cardiac output and arterio-venous 02 difference, while stroke volume and pulmonary wedge pressure (PWP) remained unchanged. At matched work load a significant reduction was observed in heart rate (HR) (128 +/- 18 vs. 122 +/- 17 beats min-1, P less than 0.001) and PWP (23 +/- 8 vs. 21 +/- 8, P less than 0.05). The extent and presence of ST-segment depression in standard ECG at E1 was not indicative of a different haemodynamic pattern or of a different response to training. During E1, 23 patients had an ischaemic threshold greater than 2700 kpm. When compared with the 23 patients with an ischaemic threshold less than or equal to 2700 kpm, they had a greater work capacity (8409 +/- 3045 vs. 4798 +/- 2552 kpm, P less than 0.05) and a lower PWP at peak exercise (19 +/- 8 vs. 27 +/- 6 mmHg, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)