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.
Highlights
Acute myocardial infarction (AMI) is the most common cause of acute heart failure, and prompt management of the acute phase in AMI patients is mandatory to prevent the transition of acute heart failure to chronic heart failure [1]
We showed that the cardiac rehabilitation (CR) group statistically had the highest mitral e’ and a’ velocities, the lowest mitral E/e’ ratio, and the lowest total number of echocardiographic parameters of diastolic dysfunction at the follow-up echocardiographic examinations in patients with AMI
Our study demonstrated results similar to those of previous studies, and the CR group showed a significant improvement in LV ejection fraction (LVEF)
Summary
Acute myocardial infarction (AMI) is the most common cause of acute heart failure, and prompt management of the acute phase in AMI patients is mandatory to prevent the transition of acute heart failure to chronic heart failure [1]. Along with coronary revascularization and anti-ischemic pharmacotherapy, cardiac rehabilitation (CR) is the best adjunctive modality associated with the improvement of symptoms and survival in patients with AMI [2,3]. Comprehensive CR is an out-patient disease management program that reduces CV mortality by approximately 25% and hospital readmissions by 18% [4,5]. CR includes coordinated activities necessary for favorably influencing the underlying causes of cardiovascular diseases; for facilitating optimal physical, mental, and social conditions; and for enabling patients to preserve or find the best possible way to function within their community [6]. The CR-associated exercise program can improve cardiac function in patients with coronary artery diseases [7,8,9]. CR can improve clinical outcomes in patients with heart failure (HF), including end-stage HF treated with a left ventricular assist device system [10]
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