Physical training improves myocardial perfusion but not left ventricular function response to exercise in patients with microvascular angina
- 1 October 2019
- journal article
- research article
- Published by Edizioni Minerva Medica in The Quarterly Journal of Nuclear Medicine and Molecular Imaging
- Vol. 63 (3), 302-310
- https://doi.org/10.23736/S1824-4785.17.02930-2
Abstract
BACKGROUND: Patients with primary microvascular angina (PMA) commonly exhibit abnormal left ventricular function (LVF) during exercise, potentially owing to myocardial ischemia. Herein, we investigated in PMA patients the effect of the reduction of myocardial perfusion disorders, by using aerobic physical training, upon LVF response to exercise. METHODS: Overall, 15 patients (mean age, 53.7 +/- 8.9 years) with PMA and 15 healthy controls (mean age, 51.0 +/- 9.4 years) were studied. All subjects were subjected to baseline resting and exercise ventriculography, myocardial perfusion scintigraphy (MPS), and cardiopulmonary testing. PMA group members then participated in a 4-month physical training program and were reevaluated via the same methods applied at baseline. RESULTS: Baseline left ventricular ejection fraction (LVEF) determinations by ventriculography were similar for both groups (PMA, 67.7 +/- 10.2%; controls, 66.5 +/- 5.4%; P=0.67). However, a significant rise in LVEF seen in control subjects during exercise (75.3 +/- 6.2%; P-0.0001) did not materialize during peak exercise in patients with PMA (67.7 +/- 10.2%; P=0.47). Of the 12 patients in the PMA group who completed the training program, 10 showed a significant reduction in reversible perfusion defects during MPS. Nevertheless, LVEF at rest (63.5 +/- 8.7%) and at peak exercise (67.3 +/- 15.9%) did not differ significantly (P=0.30) in this subset. CONCLUSIONS: In patients with PMA, reduced left ventricular inotropic reserve observed during exercise did not normalize after improving myocardial perfusion through aerobic physical training.Keywords
This publication has 35 references indexed in Scilit:
- Effects of Sex on Coronary Microvascular Dysfunction and Cardiac OutcomesJournal of the American College of Cardiology, 2014
- Coronary microvascular dysfunction: an updateEuropean Heart Journal, 2013
- The coronary circulation and blood flow in left ventricular hypertrophyJournal of Molecular and Cellular Cardiology, 2012
- Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular eventsEuropean Heart Journal, 2011
- Primary Coronary Microvascular DysfunctionJournal of the American College of Cardiology, 2010
- Low Diagnostic Yield of Elective Coronary AngiographyThe New England Journal of Medicine, 2010
- Microvascular Angina and the Continuing Dilemma of Chest Pain With Normal Coronary AngiogramsJournal of Invasive Cardiology, 2009
- The Case for Myocardial Ischemia in Hypertrophic CardiomyopathyJournal of Invasive Cardiology, 2009
- Adverse Cardiovascular Outcomes in Women With Nonobstructive Coronary Artery DiseaseJAMA Internal Medicine, 2009
- Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve.Journal of the American College of Cardiology, 1985