The effect of cardiac rehabilitation exercise training on left ventricular remodelling in patients with recent myocardial infarction
Cardiff Metropolitan University
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The present thesis examined the effect of cardiac rehabilitation (CR) exercise training on reverse left ventricular (LV) remodelling in a cohort of post-myocardial infarction (MI) patients with mildly abnormal LV ejection fraction (LVEF). Specifically, the thesis aimed to evaluate the effect of 10 weeks of exercise training on (1) the N-terminal fragment of the counter regulatory neurohormone brain natriuretic peptide (NT-pro-BNP), (2) LV structural and functional parameters through the use of conventional echocardiography, and (3) LV mechanics via the application of speckle tracking echocardiography (STE). Accordingly, a large cohort of patients completed a single longitudinal protocol to provide data for three separate experimental studies. A number of cardiovascular adaptations were observed following completion of 10 weeks of CR exercise training. Firstly, an improvement in exercise capacity was evident. Secondly, study one demonstrated that resting NT-pro-BNP was reduced and that the acute increase in NT-pro- BNP observed following bouts of maximal and submaximal exercise may be attenuated. Thirdly, in study two, LV volumetric adaptation was evidenced by reduced LV end diastolic volume (EDV) and end systolic volume (ESV). Furthermore, a positive correlation between reduced resting NT-pro-BNP and reduced EDV provided an indication of the relationship between NT-pro-BNP and reverse LV volumetric remodelling. Finally, the main finding of study three was related to LV functional adaptation, indicated by a reduction in LV twist and twist velocity. Collectively, findings from the three experimental studies presented in this thesis provide evidence of volumetric and functional reverse LV remodelling, further to 10 weeks of CR exercise training in post-MI patients. It is likely that these cardiac adaptations may contribute to the improved cardiovascular exercise capacity and reduced mortality commonly witnessed following CR exercise training in the post-MI population.
PhD Thesis - School of Sport
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