P3428Prospective controlled trial testing the effect of physical training over myocardial perfusion disturbance and quality of life in patients with primary microvascular angina: a pilot study

Abstract

Background: Primary microvascular angina (PMA) is a common condition associated with quality of life (QoL) and physical capacity (PC) deterioration, allied to frequent angina recurrence. PMA is recognized as a condition in which pharmacological interventions yield poor results in the control of ischemia and angina symptoms. Purpose:We aimed at evaluating the impact of physical training (PT) over the PC, QoL, and the extent of reversible myocardial perfusion defects (rMPD) in patients with PMA. Methods: We prospectively investigated 32 patients with PMA, characterized by effort angina, normal coronary arteries at coronary angiography and ≥2 myocardial segments with rMPD at stress‐rest Sestamibi‐Tc99m myocardial perfusion SPECT (MPS). At baseline, patients underwent SF‐36 QoL questionary, cardiopulmonary exercise test and MPS. After that, they were assigned to a PTgroup (n=23, 56±9 years old, 11 males) and a Control‐group (n=9, 53±7 years old, 8 males), which was constituted by patients that declined the invitation to participate in the PT program. The PT‐patients were submitted to 1‐hour aerobic exercise in treadmill, 3 times/week, moderate intensity (60‐85% of peak‐VO2), during 3‐months. All patients in both groups were re‐evaluated after 3‐months, with the same methods used at baseline. Results: From the baseline to the post‐training condition, we observed, respectively: 1. Significant increase in the peak‐Vo2 in the PT‐group (19.1±4.3 to 21.4±5.2 ml/kg/min, p<0.001), but not in the Control‐group (17.2±3.2 to 16.6±3.7 ml/kg/min, p>0.05); 2. Significant improvement in all the SF‐36 scores in the PT‐group, including pain (32.9±20 to 67.8±20%, p=0.0001), functional capacity (37.4±24.2 to 88.9±11.9%, p=0.0001) and general health status (46.9±26.4 to 73.5±25.1%, p=0.003), but no significant changes were detected in the Controlgroup; 3. Significant reductions of mean number of the rMPD (6.4±3.9 to 2.2±3.4, p=0.0001) and of the Stress‐Rest difference score (7.9±6.9 to 2.7±4.3, p=0.0004) for the PT‐group, but no change was seen in the Control‐group for number of rMPD (5.6±3.9 to 3.3±4.7, p=0.18) or Stress‐Rest difference score (5.5±5.3 to 4.9±7.0, p=0.56). Conclusions: Physical training is associated to significant reduction of the reversible ischemic myocardial perfusion defects in patients with PMA. This positive effect was accompanied by significant improvement of the functional capacity and quality of life. The results of this pilot study indicate that physical training may constitute a relevant therapeutic strategy in patients with PMA.