The effect of cardiac rehabilitation exercise training on left ventricular remodelling in patients with recent myocardial infarction
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Date
2013Type
Thesis
Publisher
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.
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PhD Thesis - School of Sport
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