Impact of cardiac rehabilitation exercise program on left ventricular diastolic function in coronary artery disease: A pilot study
Diastolic dysfunction is common in coronary artery disease (CAD). Exercise-based cardiac rehabilitation (CR) improves survival and quality of life but its effect on diastolic function is unclear. We sought to determine the impact of CR on diastolic function. We conducted a prospective study of CAD patients referred for 3-month outpatient CR, with pre-CR and post-CR echocardiograms. Twenty-five outpatients (age [mean ± SD], 66 ± 11 years; 7 [28 %] women; 22 [88 %] with recent acute coronary syndrome) were recruited upon beginning CR; one patient lacking follow-up was excluded from analysis. Before CR, patients' mean ejection fraction was 61 ± 7 %; regional wall motion score index was 1.18 ± 0.28; and left ventricular diastolic dysfunction existed in 21 (88 %). Of the 24 (96 %) patients with post-CR follow-up, 12 (50 %) had improved diastolic function, 2 of the 24 (8 %) had normal diastolic function throughout, nine (38 %) remained at the same grade, and one (4 %) had worsened diastolic function. The E/e' ratio improved significantly after CR (11.9 ± 4.5 vs. 10.7 ± 4.5; P = .048). Fourteen patients with normal or improved diastolic function had a greater decrease in left atrial volume index (-4.2 ± 6.3 vs. 1.6 ± 6.3 mL/m(2); P = .04) and a greater increase in peak untwisting rate (20 ± 36 vs. -42 ± 45 °/s; P = .003) than did patients with no diastolic improvement. Three-month, exercise-based CR was associated with improved left ventricular diastolic function in half of our patients. Further large studies are needed to clarify the effect of CR on diastolic dysfunction in patients with CAD.
Available from: Paul Schoenhagen
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The main aim of this study was to detect the possible early effect of cardiac rehabilitation (CR) on left atrium (LA) and left ventricle (LV) function and relation to aortic stiffness in patients with acute myocardial infarction (AMI).Methods
Fifty-four patients with AMI were enrolled in this study. Left atrial strain analysis was performed by two-dimensional speckle tracking echocardiography. The deceleration time (DT) was measured by pulsed-wave Doppler. The ratio of E/e' to LA peak strain was used to estimate the LA stiffness (Stiffnessstrain) Aortic elasticity parameters were calculated using the formulas including aortic systolic and diastolic diameter with M-Mode echocardiography and blood pressure. Anterior wall aortic expansion velocity was measured by tissue Doppler imaging.ResultsLeft ventricle ejection fraction (EF) and LA functional parameters were significantly better in trained subjects. Also in training group, the LV diastolic functional parameters were better in CR group than the control group. Aortic elasticity parameters were better with CR.Conclusions
In patients with CR, an increase in LA strain was correlated with increase in aortic strain and improved aortic distensibility, likely indicating favorable LA and aortic interactions with exercise training.
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