Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction - Results of the exercise in left ventricular dysfunction (ELVD) trial

Background Exercise is currently recommended for patients after myocardial infarction; however, the effects of regular exercise on the remodeling process remain to be defined. The aim of this multicenter, randomized study was to investigate whether a long-term physical training program influences left ventricular size and function in postinfarction patients with systolic dysfunction. Methods and Results Consecutive patients with <40% ejection fraction after a first Q-wave myocardial infarction were randomly assigned to a 6-month exercise training program (n = 39) or control group (n = 38). After 6 months, a significant increase in work capacity was observed only in the training group (from 4.462 +/- 1.095 to 5.752 +/- 1.749 kilopond-meters [Kp-m], P<.01), not in the control group (from 4.375 +/- 1.143 to 4.388 +/- 1.199 Kp-m), whereas left ventricular volumes had increased in the control group (end-diastolic volume, from 94 +/- 26 to 99 +/- 27 mL/m(2), P<.01; end-systolic volume, from 62 +/- 20 to 67 +/- 23 mL/m(2), P<.01) but not in the training group (end-diastolic volume, from 93 +/- 28 to 92 +/- 28 mL/m(2), P = NS; end-systolic volume, from 61 +/- 22 to 57 +/- 23 mL/m(2), P = NS). Conversely, ejection fraction had improved in the training group (from 34 +/- 5% to 38 +/- 8%, P<.01) but not in the control group (from 34 +/- 5% to 33 +/- 7%, P = NS). Conclusions In postinfarction patients with systolic dysfunction, long-term exercise training may attenuate the unfavorable remodeling response and even improve ventricular function over time.