Abstract
To clarify the clinical significance of the exercise test in acute myocardial infarction (AMI), the relationship between the results of exercise test and the clinical features was studied. The low level treadmill exercise test (maximum exercise time was 1080 seconds and the maximum oxygen consumption was 7 METs) were performed in 111 patients within 2 months after the onset of AMI. The exercise time, the endpoint of the exercise test, the exercise-induced ST-segment deviation and ventricular premature beats (VPC) were evaluated from the exercise tests. Among the clinical features, age, sex, the severity in the acute period (Killip's classification and Forrester's hemodynamic subset), the findings in cardioangiography (the number of diseased coronary arteries, left ventricular ejection fraction and abnormal wall motion in the left ventricle) and short term prognosis after AMI were evaluated. The prognosis was judged as poor when cardiac death, congestive heart failure, postinfarction angina, the decrease of exercise tolerance and reattack of AMI occurred, or when an aorto-coronary bypass graft or percutaneous transluminal coronary angioplasty was performed.
The exercise time was shorter in patients over the age of 60 years (578 ± 360 seconds) than in younger patients (818 ± 296 seconds), and also in females (487 ± 392 seconds) than in males (767 ±± 319 seconds). The patients classed as Forrester's hemodynamic subset IV had shorter exercise time than the others. But, there was no relationship between the exercise time and Killip's classification. Low left ventricular ejection fraction (55% or less) was associated with short exercise time and the apperance of exercise-induced VPC. But the number of diseased coronary artery and abnormal wall motion in the left ventricle were not related to the exercise test. The patients with high exercise tolerance (4.2 METs or more) in the AMI recovery period showed better prognosis than those with low exercise tolerance within one year after AMI (96% vs 50%, p<0.0001, respectively).
In conclusion, the low level exercise test in AMI was influenced by age, sex and cardiac function, and it was useful in evaluating the short term prognosis after AMI.
