From the Divisione di Cardiologia I, Istituto Cardiologico "G.M.
Lancisi," Ancona, Italy; and the Division of Cardiology, Harbor-UCLA
Medical Center, Torrance, Calif.
Correspondence to Romualdo Belardinelli, MD, Ospedale Cardiologico "G.M.Lancisi," Divisione di Cardiologia I, 60100 Ancona, Italy.
Background—There is evidence that
exercise training can induce myocardial and coronary
adaptations in both animals and humans. However, the significance of
these potentially important changes remains to be determined in
patients with ischemic heart disease and left
ventricular (LV) systolic dysfunction.
Methods and Results—To investigate whether exercise
training can improve thallium uptake and the contractile response to
low-dose dobutamine of dysfunctional
myocardium, 46 patients (42 men, 4 women; mean age, 57±9
years) with chronic coronary artery disease and impaired LV
systolic function (ejection fraction <40%) were randomly
assigned to two groups. The exercise group (n=26) underwent exercise
training at 60% of peak oxygen uptake for 8 weeks. The control group
(n=20) was not exercised. At baseline and after 8 weeks all patients
underwent an exercise test with gas exchange analysis and
stress echocardiography using low-dose
dobutamine (5 to 10 µg/kg per minute) followed by
thallium myocardial scintigraphy. Coronary
angiography was performed in 23 patients at baseline and after 8 weeks.
After 8 weeks, peak oxygen uptake increased significantly only in
trained patients (24%). Significant improvements in the contractile
response to dobutamine and thallium activity were observed
in trained patients (28% and 31%, respectively; trained versus
control: P<.001 for both). In a subgroup of trained
patients, both improvements were correlated with an increase in the
coronary collateral score (P<.005 and
P<.001, respectively).
Conclusions—Moderate exercise training improves both thallium
activity and the contractile response of dysfunctional
myocardium to low doses of dobutamine in
patients with ischemic cardiomyopathy. The
implication of this study is that even a short-term exercise
training may improve quality of life by improvement of LV
systolic function during mild-to-moderate physical activity in
patients with ischemic cardiomyopathy.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Effects of Moderate Exercise Training on Thallium Uptake and Contractile Response to Low-Dose Dobutamine of Dysfunctional Myocardium in Patients With Ischemic Cardiomyopathy
Key Words: exercise • thallium • contractility • myocardium • ischemia • cardiomyopathy
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