The effects of physical training in post-myocardial infarction patients with exercise-induced silent ischaemia

C. Opasich, G. Riccardi, J. Assandri, G. Calsamiglia, R. Forni, M. La Rovere, F. Cobelli, S. De Servi, G. Specchia

Research output: Contribution to journalArticlepeer-review

Abstract

To assess the clinical significance of monitoring during physical training in post-myocardial ischaemia (MI) patients with asympyomatic exercise-induced ischaemia, we studied 232 patients who were survivors of first recent acute MI and consecutively admitted to the same CCU, who underwent an exercise test (ET) and coronary angiography within 2 months of the acute event. We selected the 97 patients with multivessel disease. Among them, 60 showed a negative ET and no angina; 37 showed a positive ET with significant ST segment depression, 32 of them had no angina. The 37 patients with positive ET repeated the stress test within a week. In 8 of them, the 2 ETs differed because ischaemia was induced once with and once without precipitation of angina, while the workload (WL) and double product (DP) at the ischaemic threshold of 0.1 mV ST segment depression were not different. During a 4-week training period, 7 of the asymptomatic patients complained of effort angina and 3 of angina at rest. To assess training effects, we selected 60 non-consecutive patients with asymptomatic (38) and symptomatic (22) exercise-induced ischaemia. All the symptomatic and 25 asymptomatic patients followed a 4-week physical training programme based on the ischaemic threshold. The remaining 13 asymptomatic patients did not undergo physical training. The pre-training period ergometric patients were comparable between painful and pain-free patients. Training resulted in a similar increase in the WL at the ischaemic threshold (+45% in asymptomatic and +47% in symptomatic patients, both P <0.05), without any difference in the DP threshold. Comparing trained and untrained patients with asymptomatic ischaemia, there was a statistical difference in the improvement of the WL threshold (+45% in the trained and +6% in the untrained patients). In conclusion: (i) in post-MI patients with multivessel disease and ST segment depression during exercise the prevalence of asymptomatic exercise-induced ischaemia was 33%; (ii) both symptomatic and asymptomatic episodes have been found in some patients without any relationship with the amount of ischaemia; and (iii) physical training was similarly effective in modifying the ischemic threshold in painful and painless patients.

Original languageEnglish
Pages (from-to)176-180
Number of pages5
JournalEuropean Heart Journal
Volume9
Issue numberSUPPL. N
Publication statusPublished - 1988

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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