| Abstrakt: |
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 > 12 mm Hg in 42 patients and > 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, P < 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 < 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 < 0·05). At matched submaximal exercise, heart rate decreased (P < 0·05), stroke volume and arterio-venous oxygen difference increased (P < 0·05) without significant changes in cardiac output and left ventricular filling pressure. The increase in maximal work capacity was unrelated to the size of ventricular aneurysm, resting left ventricular ejection fraction or the values of pulmonary wedge pressure reached during the first ergometric test. Analysis of patients' subsets revealed that at comparable pre- and post-training work load, arterio-venous oxygen difference and stroke volume increased significantly only in patients with large aneurysm dilatation (> 40%, ejection fraction = 34 ±10%) or with pre-training exercise pulmonary wedge pressure > 30 mm Hg. No significant change in left ventricular filling pressure at rest or during exercise was observed in these patients after training.Pulmonary wedge pressure at submaximal work-load decreased significantly (24 ±6 vs 21 ±6 mm Hg, P < 0·05) only in the 37 patients showing an increase in work capacity by at least 25 W.In conclusion, even in the absence of a control group our results suggest that in uncomplicated patients with left ventricular aneurysm physical training is safe and that improvement of physical performance occurs without significant changes in the haemodynamic picture. [ABSTRACT FROM PUBLISHER] |
