Skip to main content
Log in

Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Exercise training might exert its beneficial effects on myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization. We evaluated whether long-term exercise-based cardiac rehabilitation started early after ST-elevation acute myocardial infarction (STEMI) improves myocardial perfusion and left ventricular (LV) function.

Methods

Forty-six patients with recent STEMI and residual inducible hypoperfusion were randomized into two groups: 25 enrolled in a 6-month outpatient exercise-based cardiac rehabilitation programme (group T) and 21 discharged with generic instructions for maintaining physical activity and correct lifestyle (group C). All patients underwent cardiopulmonary exercise test and dipyridamole rest gated myocardial perfusion single photon emission computed tomography within 1 week after STEMI and at 6-month follow-up.

Results

At follow-up, group T showed an improvement in peak oxygen consumption, oxygen pulse and in the slope of increase in ventilation over carbon dioxide output (all p < 0.01) associated with a reduction of stress-induced hypoperfusion (p < 0.01) and an improvement in resting and post-stress wall motion score indexes (both p < 0.01), resting and post-stress wall thickening score indexes (both p < 0.05) and resting and post-stress LV ejection fraction (both p < 0.05). On the contrary, no changes in cardiopulmonary indexes, myocardial perfusion and LV function parameters were observed in group C at follow-up.

Conclusion

Exercise training started early after STEMI reduces stress-induced hypoperfusion and improves LV function and contractility. Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with an improvement of cardiovascular functional capacity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682–92.

    Article  PubMed  Google Scholar 

  2. Giannuzzi P, Tavazzi L, Temporelli PL, Corrà U, Imparato A, Gattone M, et al. Long-term physical training and left ventricular remodeling after myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) trial. EAMI Study Group. J Am Coll Cardiol 1993;22:1821–9.

    Article  PubMed  CAS  Google Scholar 

  3. Giallauria F, Cirillo P, Lucci R, Pacileo M, De Lorenzo A, D’Agostino M, et al. Left ventricular remodelling in patients with moderate systolic dysfunction after myocardial infarction: favourable effects of exercise training and predictive role of N-terminal pro-brain natriuretic peptide. Eur J Cardiovasc Prev Rehabil 2008;15:113–8.

    Article  PubMed  Google Scholar 

  4. Giallauria F, Galizia G, Lucci R, D’Agostino M, Vitelli A, Maresca L, et al. Favorable effects of exercise-based cardiac rehabilitation after acute myocardial infarction on left atrial remodeling. Int J Cardiol 2009;136:300–6.

    Article  PubMed  Google Scholar 

  5. Leosco D, Rengo G, Iaccarino G, Golino L, Marchese M, Fortunato F, et al. Exercise promotes angiogenesis and improves beta-adrenergic receptor signalling in the post-ischaemic failing rat heart. Cardiovasc Res 2008;78:385–94.

    Article  PubMed  CAS  Google Scholar 

  6. Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, et al. Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network. Arch Intern Med 2008;168:2194–204.

    Article  PubMed  Google Scholar 

  7. Giallauria F, Lucci R, D’Agostino M, Vitelli A, Maresca L, Mancini M, et al. Two-year multicomprehensive secondary prevention program: favorable effects on cardiovascular functional capacity and coronary risk profile after acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2009;10:772–80.

    Article  Google Scholar 

  8. Hambrecht R, Adams V, Erbs S, Linke A, Kränkel N, Shu Y, et al. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 2003;107:3152–8.

    Article  PubMed  CAS  Google Scholar 

  9. Leosco D, Iaccarino G, Cipolletta E, De Santis D, Pisani E, Trimarco V, et al. Exercise restores beta-adrenergic vasorelaxation in aged rat carotid arteries. Am J Physiol Heart Circ Physiol 2003;285:H369–74.

    PubMed  CAS  Google Scholar 

  10. Milani RV, Lavie CJ, Mehra MR. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol 2004;43:1056–61.

    Article  PubMed  CAS  Google Scholar 

  11. Giallauria F, Cirillo P, D’agostino M, Petrillo G, Vitelli A, Pacileo M, et al. Effects of exercise training on high-mobility group box-1 levels after acute myocardial infarction. J Card Fail 2011;17:108–14.

    Article  PubMed  CAS  Google Scholar 

  12. Giallauria F, De Lorenzo A, Pilerci F, Manakos A, Lucci R, Psaroudaki M, et al. Long-term effects of cardiac rehabilitation on end-exercise heart rate recovery after myocardial infarction. Eur J Cardiovasc Prev Rehabil 2006;13:544–50.

    Article  PubMed  Google Scholar 

  13. Giallauria F, De Lorenzo A, Pilerci F, Manakos A, Lucci R, Psaroudaki M, et al. Reduction of N terminal-pro-brain (B-type) natriuretic peptide levels levels with exercise-based cardiac rehabilitation in patients with left ventricular dysfunction after myocardial infarction. Eur J Cardiovasc Prev Rehabil 2006;13:625–32.

    Article  PubMed  Google Scholar 

  14. Giallauria F, Lucci R, De Lorenzo A, D’Agostino M, Del Forno D, Vigorito C. Favourable effects of exercise training on N-terminal pro-brain natriuretic peptide plasma levels in elderly patients after acute myocardial infarction. Age Ageing 2006;35:601–7.

    Article  PubMed  Google Scholar 

  15. Smart N, Meyer T, Butterfield J, Faddy S, Passino C, Malfatto G, et al. Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure. Eur J Prev Cardiol 2012;19:428–35.

    Article  PubMed  CAS  Google Scholar 

  16. Rengo G, Leosco D, Zincarelli C, Marchese M, Corbi G, Liccardo D, et al. Adrenal GRK2 lowering is an underlying mechanism for the beneficial sympathetic effects of exercise training in heart failure. Am J Physiol Heart Circ Physiol 2010;298:H2032–8.

    Article  PubMed  CAS  Google Scholar 

  17. Leosco D, Rengo G, Iaccarino G, Filippelli A, Lymperopoulos A, Zincarelli C, et al. Exercise training and beta-blocker treatment ameliorate age-dependent impairment of beta-adrenergic receptor signaling and enhance cardiac responsiveness to adrenergic stimulation. Am J Physiol Heart Circ Physiol 2007;293:H1596–603.

    Article  PubMed  CAS  Google Scholar 

  18. Rinaldi B, Corbi G, Boccuti S, Filippelli W, Rengo G, Leosco D, et al. Exercise training affects age-induced changes in SOD and heat shock protein expression in rat heart. Exp Gerontol 2006;41:764–70.

    Article  PubMed  CAS  Google Scholar 

  19. Belardinelli R, Georgiou D, Ginzton L, Cianci G, Purcaro A. Effects of moderate exercise training on thallium uptake and contractile response to low-dose dobutamine of dysfunctional myocardium in patients with ischemic cardiomyopathy. Circulation 1998;97:553–61.

    Article  PubMed  CAS  Google Scholar 

  20. Laughlin MH, McAllister RM. Exercise training-induced coronary vascular adaptation. J Appl Physiol 1992;73:2209–25.

    PubMed  CAS  Google Scholar 

  21. Scheuer J. Effects of physical training on myocardial vascularity and perfusion. Circulation 1982;66:491–5.

    Article  PubMed  CAS  Google Scholar 

  22. Giallauria F, Acampa W, Ricci F, Vitelli A, Maresca L, Mancini M, et al. Effects of exercise training started within 2 weeks after acute myocardial infarction on myocardial perfusion and left ventricular function: a gated SPECT imaging study. Eur J Prev Cardiol 2012;19:1410–9.

    Google Scholar 

  23. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol 2004;44:E1–211.

    Article  PubMed  Google Scholar 

  24. Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855–97.

    Article  PubMed  CAS  Google Scholar 

  25. Cuocolo A, Petretta M, Acampa W, De Falco T. Gated SPECT myocardial perfusion imaging: the further improvements of an excellent tool. Q J Nucl Med Mol Imaging 2010;54:129–44.

    PubMed  CAS  Google Scholar 

  26. Berman DS, Abidov A, Kang X, Hayes SW, Friedman JD, Sciammarella MG, et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol 2004;11:414–23.

    Article  PubMed  Google Scholar 

  27. Ferro A, Pellegrino T, Spinelli L, Acampa W, Petretta M, Cuocolo A. Comparison between dobutamine echocardiography and single-photon emission computed tomography for interpretive reproducibility. Am J Cardiol 2007;100:1239–44.

    Article  PubMed  Google Scholar 

  28. Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation 1999;99:1173–82.

    Article  PubMed  CAS  Google Scholar 

  29. Gunning MG, Walker J, Eastick S, Bomanji JB, Ell PJ, Walker JM. Exercise training following myocardial infarction improves myocardial perfusion assessed by thallium-201 scintigraphy. Int J Cardiol 2002;84:233–9.

    Article  PubMed  Google Scholar 

  30. Hung J, Gordon EP, Houston N, Haskell WL, Goris ML, DeBusk RF. Changes in rest and exercise myocardial perfusion and left ventricular function 3 to 26 weeks after clinically uncomplicated acute myocardial infarction: effects of exercise training. Am J Cardiol 1984;54:943–50.

    Article  PubMed  CAS  Google Scholar 

  31. Beller GA, Murray GC, ErkenBrack SK. Influence of exercise training soon after myocardial infarction on regional myocardial perfusion and resting left ventricular function. Clin Cardiol 1992;15:17–23.

    Article  PubMed  CAS  Google Scholar 

  32. Venkataraman R, Belardinelli L, Blackburn B, Heo J, Iskandrian AE. A study of the effects of ranolazine using automated quantitative analysis of serial myocardial perfusion images. JACC Cardiovasc Imaging 2009;2:1301–9.

    Article  PubMed  Google Scholar 

  33. Miller DD, Verani MS. Current status of myocardial perfusion imaging after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1994;24:260–6.

    Article  PubMed  CAS  Google Scholar 

  34. Acampa W, Petretta M, Florimonte L, Mattera A, Cuocolo A. Prognostic value of exercise cardiac tomography performed late after percutaneous coronary intervention in symptomatic and symptom-free patients. Am J Cardiol 2003;91:259–63.

    Article  PubMed  Google Scholar 

  35. Linke A, Erbs S, Hambrecht R. Exercise and the coronary circulation–alterations and adaptations in coronary artery disease. Prog Cardiovasc Dis 2006;48:270–84.

    Article  PubMed  CAS  Google Scholar 

  36. Gielen S, Schuler G, Adams V. Cardiovascular effects of exercise training: molecular mechanisms. Circulation 2010;122:1221–38.

    Article  PubMed  Google Scholar 

  37. Jain A, Myers H, Sapin PM, O’Rourke RA. Comparison of symptom-limited and low level exercise tolerance tests early after myocardial infarction. J Am Coll Cardiol 1993;22:1816–20.

    Article  PubMed  CAS  Google Scholar 

  38. Brown KA, Heller GV, Landin RS, Shaw LJ, Beller GA, Pasquale MJ, et al. Early dipyridamole (99m)Tc-sestamibi single photon emission computed tomographic imaging 2 to 4 days after acute myocardial infarction predicts in-hospital and postdischarge cardiac events: comparison with submaximal exercise imaging. Circulation 1999;100:2060–6.

    Article  PubMed  CAS  Google Scholar 

  39. Heller GV, Brown KA, Landin RJ, Haber SB. Safety of early intravenous dipyridamole technetium 99m sestamibi SPECT myocardial perfusion imaging after uncomplicated first myocardial infarction. Early Post MI IV Dipyridamole Study (EPIDS). Am Heart J 1997;134:105–11.

    Article  PubMed  CAS  Google Scholar 

  40. Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011;7:CD001800.

    PubMed  Google Scholar 

Download references

Acknowledgments

We thank Mr. Mario Aurino and Mrs. Maria Calabrese for their contribution to the performance of the study.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alberto Cuocolo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Giallauria, F., Acampa, W., Ricci, F. et al. Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function. Eur J Nucl Med Mol Imaging 40, 315–324 (2013). https://doi.org/10.1007/s00259-012-2302-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-012-2302-x

Keywords

Navigation