Effect of Cardiac Rehabilitation on Left Ventricular Diastolic Function in Patients with Acute Myocardial Infarction

Abstract

Cardiac rehabilitation (CR) improves symptoms and survival in patients with acute myocardial infarction (AMI). We studied the change of diastolic function and its prognostic impact after CR. After reviewing all consecutive AMI patients from January 2012 to October 2015, we analyzed 405 patients (mean, 63.7 ± 11.7 years; 300 males) with baseline and follow-up echocardiographic examinations. We divided them into three groups according to their CR sessions: No-CR group (n = 225), insufficient-CR group (CR < 6 sessions, n = 117) and CR group (CR ≥ 6 sessions, n = 63). We compared echocardiographic parameters of diastolic dysfunction including E/e’ ratio > 14, septal e’ velocity < 7 cm/s, left atrial volume index (LAVI) > 34 mL/m2, and maximal TR velocity > 2.8 m/s. At baseline, there were no significant differences in all echocardiographic parameters among the three groups. At follow-up echocardiographic examination, mitral annular e’ and a’ velocities were higher in the CR group (p = 0.024, and p = 0.009, respectively), and mitral E/e’ ratio was significantly lower (p = 0.009) in the CR group. The total number of echocardiographic parameters of diastolic dysfunction at the baseline echocardiography was similar (1.29 vs. 1.41 vs. 1.52, p = 0.358). However, the CR group showed the lowest number of diastolic parameters at the follow-up echocardiography (1.05 vs. 1.32 vs. 1.50, p = 0.017). There was a significant difference between the No-CR group and CR group (p = 0.021). The presence of CR was a significant determinant of major adverse cardiovascular events in the univariate analysis (HR = 0.606, p = 0.049). However, the significance disappeared in the multivariate analysis (HR = 0.738, p = 0.249). In conclusion, the CR was significantly associated with favorable diastolic function, with the highest mitral e’ and a’ velocity, and the lowest mitral E/e’ ratio and total number of echocardiographic parameters of diastolic dysfunction at the follow-up echocardiographic examinations in AMI patients.

Prognostic Impact of Hybrid Comprehensive Telerehabilitation Regarding Diastolic Dysfunction in Patients with Heart Failure with Reduced Ejection Fraction—Subanalysis of the TELEREH-HF Randomized Clinical Trial

“…The authors proved that cardiac rehabilitation was significantly associated with favorable diastolic function after myocardial infarction. Those results are in contrast to our study in the HF population, but in that study authors compared patients participating in cardiac rehabilitation sufficiently with those not participating sufficiently [ 21 ].…”

Prognostic Implications of Clinical, Laboratory and Echocardiographic Biomarkers in Patients with Acute Myocardial Infarction—Rationale and Design of the ‘‘CLEAR-AMI Study’’

“…A meta-analysis of 63 studies that included 14,486 patients revealed the beneficial effect of exercise training in the context of a cardiac rehabilitation program in patients with CAD, resulting in a reduction of up to 25% in cardiovascular mortality and a concomitant decrease of 18% in hospital readmissions [47]. In addition, substantial evidence demonstrates the positive influence of cardiac rehabilitation on left ventricular diastolic function, a parameter closely linked to exercise tolerance [48]. Thus, the implementation of a cardiac rehabilitation program in our study will significantly improve the outcome and the quality of life of our patients.…”

Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction

“…In HF patients with reduced EF ≤45%, CR was associated with improved VAC and mechanical efficiency [ 38 ]. CR in patients with MI was also associated with improvements in LV diastolic function, as well as LV systolic function, including EF and regional wall motion abnormality, as assessed using echocardiography [ 13 , 39 ]. However, impact of CR on aortic afterload and VAC in patients with AMI and preserved or mildly reduced EF has not been evaluated yet.…”