Ho-Min Yoon, Seung-Jae Joo, Ki Young Boo, Jae-Geun Lee, Joon-Hyouk Choi, Song-Yi Kim, So Young Lee
Abstract
To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study aimed to investigate the impact of CR on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) were calculated from the stroke volume and brachial systolic blood pressure. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms.
Introduction
Acute myocardial infarction (AMI) is the leading cause of cardiac death and heart failure (HF) worldwide [1,2]. After receiving initial emergency care and reperfusion therapy, evidence-based long-term treatment is necessary to improve clinical outcomes. To prevent the progression of HF, hospitalization due to HF and cardiac death in patients with AMI, comprehensive cardiac rehabilitation (CR) is strongly recommended in the guidelines [3,4]. This rehabilitation program includes exercise training, the management and control of cardiovascular risk factors, and dietary advice [5].
Materials and method
Patients who were hospitalized for AMI, underwent successful coronary reperfusion, were scheduled a comprehensive CR program, and agreed to take part in the study were consecutively enrolled from June 25, 2020 to May 31, 2021. Exclusion criteria included patients with reduced EF ≤40%, valvular heart diseases, thyroid diseases, a history of stroke within one year, or those not in sinus rhythm. Patients who did not have follow-up echocardiographic or hemodynamic data were also excluded from the study. This study was conducted in accordance with the Declaration of Helsinki.
Results
A total of 90 patients with AMI were consecutively enrolled. After excluding 5 patients with a significant aortic stenosis and 56 patients lacking follow-up echocardiographic or hemodynamic data, 29 patients were included in this study. Among them, 8 patients did not participate in the outpatient CR program. They were classified as the non-CR group. Other 21 patients constituted the CR group.
Discussion
The primary findings of this study indicate that in patients with AMI and preserved or mildly reduced EF, increased aortic afterload and ventricular-arterial (VA) mismatch were associated with a negative impact on both LV diastolic and systolic function. Additionally, the outpatient CR program not only reduced aortic afterload but also improved LV diastolic and systolic dysfunction.
Conclusions
Increased aortic afterload and VA mismatch were associated with a negative impact on both LV diastolic and systolic function. The outpatient CR program decreased aortic afterload and improved LV diastolic and systolic dysfunction, supporting its beneficial role in patients with AMI and preserved or mildly reduced EF.
Citation: Yoon H-M, Joo S-J, Boo KY, Lee J-G, Choi J-H, Kim S-Y, et al. (2024) Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction. PLoS ONE 19(4): e0300578. https://doi.org/10.1371/journal.pone.0300578
Editor: Niema M. Pahlevan, University of Southern California, UNITED STATES
Received: November 23, 2023; Accepted: February 29, 2024; Published: April 4, 2024
Copyright: © 2024 Yoon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The original full dataset is in the Supporting Information files as S1 Dataset.
Funding: This research was supported by a research grant (JNUH 2019-05) by Jeju National University Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0300578#sec018
