M.537. Early improvement in exercise test results following myocardial infarction

Abstract

Cardiac rehabilitation relies on understanding the pathogenesis of coronary heart disease and the role of risk factors. Lifestyle adjustments include early mobilization, physical training, and achieving psychological balance. Ideally changes ought to start very early following myocardial infarction and include infolTnation about the aims of the program and prognostic value of diagnostic and therapeutic procedures. To assess whether the perfolTnance and results of exercise tests can be improved safely in a set of patients with a first myocardial infarction we granted them a second opportunity; following an extensive explanation the exercise test was repeated within 3 hours. A total of 137 patients wele studied between days 5 and 7 following admission, ischemia, hemodynamic data and subjective effort perception (Borg scale) were measured in both tests. Demographic features included gender (82%males), mean age 54 +10 years old, 72% had overweight (body mass index 28.7 +4), hypertension (55%), diabetes (24%), dyslipidemia (55%), current smokers (61%), seden- tarism (75%), Q wave MI (68%), good ventricular function (ejection fi'action >50%; range 25-65). Ischemia threshold and recovery time were similar in both tests. But statistical diffelences were found regm'ding exercise time which improved fi'om 5.9 to 7.7 minutes (p<0.0001), METS increased fi'om 7.04 to 8.82 (p<0.0001), double product raised fi'om 19659 to 22310 (p<0.0001), baseline heart rate decreased fi'om 72 to 65 beats/minute (p<0.001), and the maximum rate augmented fi'om 124 to 133 beats/minute (p<0.0001). Moreover, the negative perception of effort according to Borg scale improved significantly with the second test (12.6 +1.8 vs. 10.7 +1.8; p<0.002). In conclusion: our data show significant benefit of a second exercise test. We often forget the value of repeating simple and inexpensive tests as a way to clm'ify certain difficult cases.