BackgroundRegular exercise training has been shown to reduce mortality, improve functional capacity; and control the risk factors in myocardial infarction (MI) patients. Heart rate recovery (HRR) is a strong independent mortality predictor in patients with previous MI.AimThe main objective of this study was to investigate the impact of exercise training on heart rate recovery in patients post anterior myocardial infarction.MethodsWe recruited patients one month after having anterior MI who were referred to cardiac rehabilitation (CR) clinic in Ain Shams University hospital between October 2016 and July 2017. All the patients participated in exercise training sessions 3 times a week for 12 weeks. Symptom limited treadmill exercise test was done before and after exercise training program to calculate heart rate recovery in 1st minute (HRR1) and 2nd minute (HRR2).ResultsA total of 50 patients, including 44 (88%) males, completed the exercise training program. The mean age was 51 years. Statistically significant improvement in HRR1 and HRR2 was observed (p value <0.001) after completion of exercise based cardiac rehabilitation program. Significant improvement in resting heart rate was also observed (p value <0.001). Moreover, metabolic equivalent (METs) and HR reserve were improved significantly (p value <0.001). No statistically significant changes were observed in resting systolic and diastolic blood pressures and maximum HR (p value = 0.95, 0.76 and 0.31 respectively).ConclusionExercise training improves HRR, resting HR, METs and HR reserve in post anterior MI patients.

This prospective cohort study evaluated the association between the renin angiotensin aldosterone system genotypes and response to spironolactone in 155 Egyptian patients with heart failure with reduced ejection fraction (HFrEF). Genotype frequencies for AGT rs699 were: CC = 16%, CT = 48%, and TT = 36%. Frequencies for CYP11B2 rs1799998 were: TT = 33%, TC = 50%, and CC = 17%. After 6 months of spironolactone treatment, change in the left ventricular ejection fraction (LVEF) differed by AGT rs699 (CC, 14.6%; TC, 7.9%; TT, 2.7%; P = 2.1E‐26), and CYP11B2 rs1799998 (TT, 9.1%; TC, 8.7%; CC, 1.4%; P = 0.0006) genotypes. Multivariate linear regression showed that the AGT rs699 and CYP11B2 rs1799998 polymorphisms plus baseline serum potassium explained 71% of variability in LVEF improvement (P = 0.001), 63% of variability in serum potassium increase (P = 2.25E‐08), and 39% of the variability in improvement in quality of life (P = 2.3E‐04) with spironolactone therapy. These data suggest that AGT and CYP11B2 genotypes as well as baseline serum K are predictors of spironolactone response in HFrEF.

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Background: Estimation of left ventricular function has major diagnostic and prognostic importance in cardiac patients. The most commonly used measure of the systolic function of the left ventricle is ejection fraction (EF), however, the accuracy is limited especially in patients with poor image quality. Mitral annular plane systolic excursion (MAPSE) and tissue Doppler peak systolic velocity (TD PSV) are measurements of longitudinal function which has been shown to correlate with LV global systolic function. Objective:To validate the correlation of mitral annular plane systolic excursion (MAPSE) and TD PSV (Sm) at the medial and lateral mitral annuli as surrogates for estimation of LV systolic function. Methods:The study included 200 patients divided into 2 groups; Group (A) which included 100 patients with normal EF as assessed by biplane Simpson's method (defined as EF>50%) and Group (B) which included 100 patients with reduced ejection fraction (defined as EF<50%). MAPSE and TD PSV (Sm) were recorded at medial and lateral mitral annuli in the apical four-chamber approach. Results:The cut off value of MAPSE at medial annulus of ≤ 7mm suggested an impaired systolic function with sensitivity of 73 % and specificity of 100%. While the cut off value of MAPSE at lateral annulus of ≤ 10mm suggested an impaired systolic functions with sensitivity of 82% and specificity of 93%. TD PSV (Sm) cut off value at the Medial and lateral annuli ≤ 7cm/s suggested an impaired LV systolic function with sensitivity of 91% and specificity of 85% for the medial annulus and with sensitivity of 72% and specificity of 93% for the lateral annulus. When the cut-off values of both parameters (TD PSV and MAPSE) were combined to detect LVEF<50, the sensitivity and specificity increased to 95.9% and 100 % respectively for the Medial Mitral annulus and 85.5% and 97.7% respectively for the lateral Mitral annulus Conclusion: Combining the measurement of both MAPSE and Mitral annular TD PSV increased their sensitivity and specificity for predicting normal or subnormal EF.