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Physical training reduces microvascular ischemia and improves left ventricular systolic function in patients with non-ischemic dilated cardiomyopathy and microvascular dysfunction

Session Poster Session 3

Speaker Associate Professor Marcus Vinicius Simoes

Event : Heart Failure 2018

  • Topic : preventive cardiology
  • Sub-topic : Cardiovascular Rehabilitation
  • Session type : Poster Session

Authors : MV Simoes (Ribeirão Preto,BR), EEV Carvalho (Ribeirão Preto,BR), JC Crescencio (Ribeirão Preto,BR), DM Tanaka (Ribeirão Preto,BR), LFL Oliveira (Ribeirão Preto,BR), PV Schwartzmann (Ribeirão Preto,BR), CQ Bertini (Ribeirão Preto,BR), A Schmidt (Ribeirão Preto,BR), L Gallo-Junior (Ribeirão Preto,BR), JA Marin-Neto (Ribeirão Preto,BR)

Authors:
MV Simoes1 , EEV Carvalho1 , JC Crescencio1 , DM Tanaka1 , LFL Oliveira1 , PV Schwartzmann1 , CQ Bertini1 , A Schmidt1 , L Gallo-Junior1 , JA Marin-Neto1 , 1Medical School of Ribeirão Preto - University of São Paulo, Brazil - Ribeirão Preto - Brazil ,

Citation:

Background: Myocardial ischemia with normal coronary arteries at angiography, characterizing the presence of coronary microvascular dysfunction (CMD), may be detected in 30-50% of patients with non-ischemic dilated cardiomyopathy (DCM) and is a marker of worse prognosis. However, there is a lack of studies assessing the impact of therapeutic measures targeting CMD in this clinical context.
Purpose: We aimed at testing the effect of physical training over the extent/severity of myocardial perfusion defects and left ventricular systolic function in patients with CMD associated to DCM.
Methods: We prospectively investigated 20 patients with DCM presenting CMD characterized by chest pain, normal coronary arteries at angiography, and detection of =2 myocardial segments with reversible perfusion defects during stress-rest Tc-99m-Sestamibi myocardial perfusion-SPECT imaging (MPI). Patients were assigned to a Training Group (TG - n=11, 5 men, age = 60.0±7,8 y. o., mean NYHA functional class = 1.8±0.4) and Control Group (CG - n=9, 5 men, age = 55.8±12 y.o., mean NYHA functional class = 2.0±0.5). At baseline and 3 months afterwards, both groups underwent MPI including evaluation of left ventricular ejection fraction (LVEF) by using gated-SEPCT images, cardiopulmonary exercise test (CPT) and quality of life (QOL) evaluation by using the SF36 questionnaire.  The patients of the TG were submitted to aerobical physical training during 3 months, consisting of 1-hour treadmill sessions, 3 times/week, moderate intensity (60 to 85% of the peak-VO2). The myocardial perfusion defects were visually graded using a semi-quantitative score (0=normal uptake; 4 = absent uptake) in a left ventricular 17-segment model. Summed reversibility score (RS) was calculated by subtracting the rest summed score from the stress summed score.
Results: The CG presented no significant difference between the baseline and post 3 months evaluation for all investigated variables. However, the TG patients exhibited significant reduction of the RS from baseline to the post-training evaluation (7.7±3.9 to 2.4±4.7, respectively, p=0.003), reduction of the number of segments with reversible defects (6.9±2.9 to 2.9±4.1, respectively, p=0.007), increasing of the LVEF (39.6±20.5 to 44.8±20.7%, respectively,  p=0.02), increasing of the physical capacity measured by the peak-VO2 (16.3±3.9 to 18.7±3.5 ml/Kg/min, respectively, p<0.003) and by the VO2 at the anaerobic threshold (10.4±2.0 to 12.9±3.0 ml/Kg/min, respectively, p=0,001). We observed significant improvement in all domains of the SF-36 scores.
Conclusions: Physical training was associated to significant reduction of the extent/severity of reversible myocardial perfusion defects in patients with DCM and coronary microvascular dysfunction. This positive effect was also associated to improvement of the LVEF and QOL scores. Our results suggest that physical training is a relevant therapy for coronary microvascular dysfunction in DCM patients.

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