Effects of exercise training on left ventricular volumes and function in patients with nonischemic cardiomyopathy: Application of magnetic resonance myocardial tagging

Abstract

Background Exercise training is now an accepted component of the therapeutic regimen in patients with heart failure and underlying ischemia, but few data are available on the effects of training in patients with nonischemic dilated cardiomyopathy. Methods Twenty-four patients (mean age 55 ± 9 years, mean ejection fraction 26.6% ± 10%) were randomized to an exercise (n = 12) or a control (n = 12) group. Patients in the exercise group underwent 5 45-minute sessions of supervised training per week. Before and after the 2-month study period, exercise testing with respiratory gas exchange and lactate analysis was performed, left ventricular volumes and ejection fraction were measured with magnetic resonance imaging, and left ventricular rotation and relaxation velocities were measured with a novel magnetic resonance imaging tagging technique. Results Training resulted in increases in peak oxygen uptake (VO2) (21.7 ± 4 mL/kg/min to 25.3 ± 5 mL/kg/min, P <.05) and VO2 at the lactate threshold (12.8 ± 4 mL/kg/min to 19.0 ± 5 mL/kg/min, P <.01). No differences were observed within or between groups in left ventricular end-diastolic volume, end-systolic volume, or ejection fraction. Velocity of left ventricular rotation during systole was unchanged in both groups, and relaxation velocity was higher after training in the exercise group (21.2 ± 5 degrees/s versus 29.7 ± 12 degrees/s, P <.05). Conclusion Training resulted in increases in peak VO2 and VO2 at the lactate threshold. Left ventricular volumes and systolic function (ie, ejection fraction and rotation velocity) were unchanged with training, suggesting that training in patients with dilated cardiomyopathy does not lead to further myocardial damage. However, the increase in relaxation velocity after exercise training indicates an improvement in diastolic function. The latter finding suggests an additional potential benefit of exercise training in patients with dilated cardiomyopathy. (Am Heart J 2002;144:719-25.)