Feasibility of physical training in post-infarct patients with left ventricular aneurysm: a haemodynamic study

To investigate the haemodynamic changes after physical training in patients with left ventricular aneurysm, 60 uncomplicated patients, mean age 51 +/- 10 years, underwent a maximal ergometric test in the supine position with haemodynamic monitoring (Swan-Ganz catheter) 37 +/- 10 days from acute myocardial infarction and after a 4-week period of supervised physical training. The size of aneurysmatic dilatation (aneurysm area-total end-diastolic area ratio %) and resting left ventricular ejection fraction (Dodge's method) were obtained from a two-dimensional echocardiogram (apical approach) performed on the same day of the pre-training ergometric test. On average, left ventricular ejection fraction was reduced (39 +/- 11%), with values below 35% in 25 patients. Resting pulmonary wedge pressure was greater than 12 mm Hg in 42 patients and greater than 20 mm Hg at peak exercise in 48 subjects. The entity of aneurysmatic dilatation was significantly related to left ventricular ejection fraction (r = 0.60, less than 0.001), but not to the values of pulmonary wedge pressure at rest (r = 0.22) or at peak exercise (r = 0.11). No complication during the physical training period was observed. After training, maximal work capacity increased (77 +/- 29 vs 94 +/- 35 W, P less than 0.001) as well as cardiac output and stroke volume with a slight change in pulmonary wedge pressure (24 +/- 7 vs 28 +/- 7 mm Hg, P less than 0.05). At matched submaximal exercise, heart rate decreased (P less than 0.05), stroke volume and arterio-venous oxygen difference increased (P less than 0.05) without significant changes in cardiac output and left ventricular filling pressure.(ABSTRACT TRUNCATED AT 250 WORDS)