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Functional Significance of Atrial Remodeling One Year After Infarction: Relationship with Performance and Response to Cardiac Rehabilitation
Session:
Sessão de Posters 35 - Medir o que importa na reabilitação cardíaca
Speaker:
Benedita Couto Viana
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Benedita Couto Viana; Erivaldo Andrade
Abstract
<p><strong>Introduction:</strong></p> <p>Atrial remodeling (AR) after acute myocardial infarction (AMI) may reflect the severity of ischemic injury or a chronic substrate linked to cardiovascular risk factors. These persistent alterations are markers of increased hemodynamic load and reduced functional reserve. Their influence on recovery during cardiac rehabilitation (CR) remains uncertain.</p> <p><strong>Methods:</strong></p> <p>We studied 148 consecutive patients admitted with AMI (2013–2015) to a tertiary care center who subsequently completed a structured CR program initiated about one month after the event and lasting 8–12 weeks. AR was assessed at one year using the Atrial Remodeling Score (ARS) (0 = none; ≥1 = remodeling), integrating: 1) structural—left atrial volume index >34 mL/m²; 2) electrical—presence of at least two of the following abnormalities: P-wave duration ≥120 ms, P-wave terminal force in V1 ≤ –4000 µV·ms, or advanced interatrial block; and 3) biochemical—BNP in the upper tertile (≥56.1 pg/mL). Functional parameters at CR entry and completion were compared across ARS categories.</p> <p><strong>Results:</strong></p> <p>Baseline characteristics included a mean age of 54.5 ± 10.0 years, 87% male, BMI 27.2 ± 3.2 kg/m², smoking in 74%, dyslipidemia in 64.9%, hypertension in 38.5%, diabetes in 15.6%, and STEMI in 69.6%. AR status was available for 134 patients, of whom 54 (40.3%) had AR. The mean number of CR sessions was 12.7 ± 4.0. At baseline, patients with AR showed lower MET performance (8.13 ± 2.32 vs. 8.75 ± 2.05; p=0.088) and consistent trends toward reduced energy expenditure (p=0.057), higher perceived exertion (p=0.073), and higher double product (p=0.090), indicating a less favorable initial hemodynamic profile. Improvement in METs during CR was significantly greater in the AR group (2.67 ± 1.40 vs. 2.10 ± 1.61; p=0.027). Final functional capacity remained comparable between groups despite persistent AR (10.79 ± 2.30 vs. 10.85 ± 2.15; p=0.97).</p> <p><strong>Conclusions:</strong></p> <p>AR at one year may represent a structural remnant of more severe ischemic injury or a pre-existing substrate associated with a less favorable early hemodynamic response, identifying patients who begin CR in a more compromised functional state. Nevertheless, these individuals achieved similar—and proportionally greater, owing to a lower baseline—functional gains, indicating that AR does not limit the benefit derived from post-infarction rehabilitation.</p>
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