RESUMEN
Objetivo: Determinar los efectos del entrenamiento físico prolongado sobre la función y remodelación del ventrículo izquierdo después del infarto miocárdico. Métodos: Fueron estudiados 90 pacientes con un primer infarto miocárdico agudo, de localización anterior; todos recibieron el tratamiento médico convencional. Se realizaron pruebas de esfuerzo máximas, ecocardiogramas y ventriculografías isotópicas en reposo y esfuerzo a los 2, 6 y 12 meses de evolución; el seguimiento clínico medio fue de 36.3 ± 17 meses. A todos se les incorporó a un programa de rehabilitación cardíaca con entrenamiento físico moderado o intenso, durante un año como mínimo. Un 41.1% tuvieron una disfunción severa del ventrículo izquierdo. Resultados: Todos los parámetros ergométricos que expresaron capacidad funcional incrementaron significativamente en la evaluación del sexto mes (p < 0.0005), permaneciendo invariables al año. Se comprobó una disminución significativa (p < 0.01) de isquemia miocárdica al esfuerzo a los 6 meses. Las variables que midieron tamaño y función del ventrículo izquierdo no se modificaron evolutivamente. La mortalidad total de la serie fue un 13.3%, de causa cardiovascular un 8.9% y la morbilidad un 16.7%. Conclusiones: El entrenamiento físico prolongado no mostró efectos deletéreos sobre la función y remodelación del ventrículo izquierdo y se obtuvieron efectos funcionales y clínicos beneficiosos en estos pacientes infartados rehabilitados.
Objective: To assess the effects of long-term exercise training on the function and remodeling of the left ventricle after myocardial infarction. Methods: We studied 90 patients with a first acute anterior-wall myocardial infarction, all received conventional medical treatment. Symptom-limited maximal exercise stress tests, echocardiograms and effort-rest isotopic ventriculographies at 2, 6 and 12 months after myocardial infarction were performed; the follow-up time averaged 36.3 ± 17 months. All patients joined a cardiac rehabilitation program with moderate or intense exercise training lasting at least a year. Of all patients, 41.1% suffered severe left ventricle dysfunction. Results: Ergometric parameters that expressed functional capacity increased significantly (P< .0005) at the sixth month evaluation and remained unchanged after a year. There was significant decrease (P< .01) of exercise myocardial ischemia at 6 months. The variables that measured size and function of left ventricle did not change during evolution. Morbidity amounted to 16.7% and total mortality of the series was 13.3%, with 8.9% of cardiovascular cause. Conclusions: Long-term exercise training showed no deleterious effects on left ventricle function or remodeling and beneficial functional and clinical effects were obtained in these rehabilitated postinfarction patients.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto de la Pared Anterior del Miocardio/fisiopatología , Infarto de la Pared Anterior del Miocardio/rehabilitación , Terapia por Ejercicio , Función Ventricular Izquierda/fisiología , Remodelación Ventricular/fisiología , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To assess the effects of long-term exercise training on the function and remodeling of the left ventricle after myocardial infarction. METHODS: We studied 90 patients with a first acute anterior-wall myocardial infarction, all received conventional medical treatment. Symptom-limited maximal exercise stress tests, echocardiograms and effort-rest isotopic ventriculographies at 2, 6 and 12 months after myocardial infarction were performed; the follow-up time averaged 36.3±17 months. All patients joined a cardiac rehabilitation program with moderate or intense exercise training lasting at least a year. Of all patients, 41.1% suffered severe left ventricle dysfunction. RESULTS: Ergometric parameters that expressed functional capacity increased significantly (P<.0005) at the sixth month evaluation and remained unchanged after a year. There was significant decrease (P<.01) of exercise myocardial ischemia at 6 months. The variables that measured size and function of left ventricle did not change during evolution. Morbidity amounted to 16.7% and total mortality of the series was 13.3%, with 8.9% of cardiovascular cause. CONCLUSIONS: Long-term exercise training showed no deleterious effects on left ventricle function or remodeling and beneficial functional and clinical effects were obtained in these rehabilitated postinfarction patients.