Role of physiological ischemia training in suppressing ventricular remodeling and ventricular arrhythmia in patients after myocardial infarction: a randomized controlled trial

Objectives: The randomized controlled study explored whether physiological ischemia training (PIT) can inhibit ventricular remodeling and reduce ventricular arrhythmias in the early period of acute myocardial infarction (AMI). Methods: AMI patients with hypotension or bradycardia were randomly divided into PIT (n = 21) and control (n = 20) groups. Meanwhile, patients with normal blood pressure (BP) and heart rate (HR) were randomly divided into PIT+angiotensin-converting enzyme inhibitor (ACEI) and/or beta-blocker (AB) (n = 30) and AB (n = 30) groups. PIT was performed in the PIT and PIT+AB groups. Finally, indicators of renin-angiotensin-aldosterone system (RAAS) activity, ventricular remodeling, cardiac function, vascular neovascularization, and ventricular arrhythmias were compared among the groups after 3 months of intervention. Results: Indicators of RAAS activity, ventricular remodeling, left ventricular ejection fraction (LVEF) and QT dispersion (QTd) were improved in the PIT, PIT+AB and AB groups after 3 months of intervention (P < 0.05). Improvements in the indicators of RAAS activity, ventricular remodeling, LVEF and QTd in the PIT+AB group were superior to those in the AB group by the end of training (P < 0.05). The levels of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in circulating blood were higher significantly in the PIT and PIT+AB groups after 3 months of intervention (P < 0.05). The Lown classification in the PIT+AB group decreased more than in other groups, and there was a significant difference compared with the control group (P < 0.05). Diastolic BP increased to some extent during PIT, whereas systolic BP or HR showed no significant effects. Conclusions: These findings suggest that PIT can effectively inhibit early ventricular remodeling, thereby reducing the risk of ventricular arrhythmias after myocardial infarction, and patients can further benefit from a combination of PIT and ACEIs/angiotensin receptor blockers and beta-blockers.