on August 5, 2002
Published online before print August 5, 2002, doi: 10.1161/01.CIR.0000027565.12764.E1
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Submitted on March 29, 2002
From Centro Medico di Montescano (M.T.L.R., M.G.), Fondazione "Salvatore Maugeri" IRCCS, Montescano, Pavia; Department of Cardiology (C.B., M.G., P.J.S.), University of Pavia and Policlinico S Matteo IRCCS, Pavia; and Division of Cardiology (G.S.), Policlinico di Monza, Italy. * To whom correspondence should be addressed. E-mail: PJQT{at}compuserve.com.
Background—Despite the rational expectation for a survival benefit produced by exercise training among post--myocardial infarction (MI) patients, direct evidence remains elusive. Clinically, changes in autonomic balance toward lower vagal activity have consistently been associated with increased mortality risk; conversely, among both control and post-MI dogs, exercise training improved vagal reflexes and prevented sudden death. Accordingly, we tested the hypothesis that exercise training, if accompanied by a shift toward increased vagal activity of an autonomic marker such as baroreflex sensitivity (BRS), could reduce mortality in post-MI patients. Methods and Results—Ninety-five consecutive male patients surviving a first uncomplicated MI were randomly assigned to a 4-week endurance training period or to no training. Age (51±8 versus 52±8 years), site of MI (anterior 41% versus 43%), left ventricular ejection fraction (52±13 versus 51±14%), and BRS (7.9±5.4 versus 7.9±3.4 ms/mm Hg) did not differ between the two groups. After 4 weeks, BRS improved by 26% (P=0.04) in trained patients, whereas it did not change in nontrained patients. During a 10-year follow-up, cardiac mortality among the 16 trained patients who had an exercise-induced increase in BRS Conclusions—Post-MI exercise training can favorably modify long-term survival, provided that it is associated with a clear shift of the autonomic balance toward an increase in vagal activity.
Revised on June 5, 2002
Accepted on June 7, 2002
Exercise-Induced Increase in Baroreflex Sensitivity Predicts Improved Prognosis After Myocardial Infarction
Maria Teresa La Rovere MD,
3 ms/mm Hg (responders) was strikingly lower compared with that of the trained patients without such a BRS increase (nonresponders) and that of the nontrained patients (0 of 16 versus 18 of 79 [23%], P=0.04). Cardiac mortality was also lower among responders irrespective of training (4% versus 24%, P=0.04).
Key words: baroreceptors • death, sudden • exercise • myocardial infarction • nervous system, autonomic
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