Abstract 13764: Impact of Endothelial Dysfunction Improvement After Exercise Training on Prognosis in Patients With Recent Myocardial Infarction.
Background: In coronary artery disease the endothelial dysfunction is an important predictor of cardiac events. Exercise training (ET) is associated with an improvement of endothelial function (EnF), but little is known about the relative impact of this improvement on long-term prognosis.
Purpose: To prospectively evaluate the effect of ET on EnF in a group of 604 low-risk patients after a first recent acute myocardial infarction (AMI) and the prognostic impact of EnF changes on cardiac events.
Methods: EnF was evaluated before and after ET (3 sessions per week, during 4 weeks, followed by 1 session /month during 12 months), by measuring flow-mediated dilation (FMD) and von Willebrand factor levels at baseline, after 1 month-ET and after 12 months. Patients were randomized into two groups: a) group 1 (G1): combined resistance and aerobic training (n=306); and b) group 2 (G2): no training, (n=298). Clinical follow-up was conducted after 12 ant 24 months.
Results: At baseline FMD was 4.3±2.3% in G1, 4.2±1.7% in G2 (p=ns). After ET the FMD had increased to 9.5±2.3% in G1 (p<0.01 vs baseline); FMD had also increased in G2, but to a much lesser extent (to 5.5±2.1%) (p<0.01 vs trained group). The von Willebrand factor level after ET decreased by 15.5% (p<0.01) in G1, but remained unchanged in G2. After 1 year FMD and von Willebrand factor were unchanged in G1 and in G2 compared to 1 month-ET follow-up. At 1 year no differences were observed in total and cardiovascular mortality and myocardial infarction in the two groups, but G1 trained patients had a lower rate of hospital readmission for non-fatal cardiovascular events (chest pain, angina, heart failure) than controls (13.9 vs. 29.2%, RR: 0.71, 95% confidence interval: 0.60 to 0.91, P=0.006). After 2 years follow-up, a significant (p=0.003) reduction in the incidence of non fatal myocardial infarction was also observed only in G1 trained pts. Multivariate logistic regression analysis demonstrated that FMD levels after ET were the only significant predictor of total events at 1 and 2-years follow-up (p <0.001).
Conclusions: in our low-risk post-myocardial infarction patients the improvement in EnF after ET was associated with a positive impact on non-fatal cardiovascular events and hospital readmission.
- © 2010 by American Heart Association, Inc.