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CLINICAL STUDY: RADIONUCLIDE IMAGING

Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy

Kira Q. Stolen, MS^*, Jukka Kemppainen, MD^*, Heikki Ukkonen, MD^*, Kari K. Kalliokoski, PhD^*, Matti Luotolahti, MD, Pertti Lehikoinen, PhD^*, Helena Hämäläinen, MD, Tiina Salo, MD, K. E. Juhani Airaksinen, MD, Pirjo Nuutila, MD^* and Juhani Knuuti, MD^*,*

^* Turku PET Centre, University of Turku and Turku University Central Hospital, Turku, Finland
Departments of Clinical Physiology, University of Turku and Turku University Central Hospital, Turku, Finland
Departments of Medicine, University of Turku and Turku University Central Hospital, Turku, Finland
Social Insurance Institution, Turku, Finland

Manuscript received May 31, 2002; revised manuscript received July 10, 2002, accepted August 26, 2002.

^* Reprint requests and correspondence: Prof. Juhani Knuuti, Turku PET Centre, P.O. BOX 52, FIN-20521 Turku, Finland.
juhani.knuuti{at}tyks.fi

OBJECTIVES: The aim of this study was to determine the effect of exercise training on myocardial oxidative metabolism and efficiency in patients with idiopathic dilated cardiomyopathy (DCM) and mild heart failure (HF).

BACKGROUND: Exercise training is known to improve exercise tolerance and quality of life in patients with chronic HF. However, little is known about how exercise training may influence myocardial energetics.

METHODS: Twenty clinically stable patients with DCM (New York Heart Association classes I through III) were prospectively separated into a training group (five-month training program; n = 9) and a non-trained control group (n = 11). Oxidative metabolism in both the right and left ventricles (RV and LV) was measured using [¹¹C]acetate and positron emission tomography. Myocardial work power was measured using echocardiography. Myocardial efficiency for forward work was calculated as myocardial work power per mass/LV oxidative metabolism.

RESULTS: Significant improvements were noted in exercise capacity (VO₂) and ejection fraction in the training group, whereas no changes were observed in the non-trained group. Exercise training reduced both RV and LV oxidative metabolism and elicited a significant increase in LV forward work efficiency, although no significant changes were observed in the non-trained group.

CONCLUSIONS: Exercise training improves exercise tolerance and LV function. This is accompanied by a decrease in biventricular oxidative metabolism and enhanced forward work efficiency. Therefore, exercise training elicits an energetically favorable improvement in myocardial function and exercise tolerance in patients with DCM.

Abbreviations and Acronyms   BP   blood pressure   DCM   dilated cardiomyopathy   HF   heart failure   HR   heart rate   kmono   [11C]acetate clearance rate   LV   left ventricle or ventricular   NYHA   New York Heart Association   PET   positron emission tomography   ROI   region of interest   RV   right ventricle or ventricular   VO2   oxygen uptake

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