Exercise Testing after Nontransmural Myocardial Infarction

Abstract

In order to ascertain the prognostic value of exercise testing in patients suffering nontransmural myocardial infarction, 74 patients performed a bicycle-ergometric test 4 weeks after the onset of the illness. The test induced angina and/or ischemic changes of ECG in 33 (group B) patients and no ischemic abnormalities in 41 (group A) patients. Following the exercise testing, all the patients performed a similar supervised exercise training program. Group A patients increased both their maximal work capacity (MWC) (mean + 26.4%, P < 0.001) and their total work performed (TWP) (mean + 54.8%, p < 0.001). 1 patient suffered a new transmural infarction during the training period. Although group B patients similarly increased their MWC (mean + 16.0%, P < 0.001) and TWP (mean + 30.0%, p < 0.005), 1 patient died suddenly and 1 patient experienced a new transmural infarction during the training period. In addition, another 2 group B patients stopped their training program due to the onset of recurrent angina at rest. Coronary angiographic examination was performed on 20 patients of each group within 12 weeks of the acute nontransmural myocardial infarction. The percentage of normal coronary angiographic findings and single, double, triple coronary vessels disease was: group A: 30, 45, 20 and 15%; group B: 0, 10, 30 and 60%. During the 12-month follow-up period, 1 patient of group A had an aortic coronary bypass operation. In contrast, group B patients had many clinical events: 4 died suddenly, 7 suffered recurrent episodes of angina pectoris, 6 underwent an aortic coronary bypass operation, 2 developed left ventricular insufficiency. The data suggest that the results of the exercise testing, 4 weeks after a nontransmural myocardial infarction, have predictive value for atherosclerotic coronary involvement and can be useful to estimate the long-term prognosis of these patients.