Short- and Long-Term Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Left Ventricular Remodeling in Patients Early After ST-Segment Elevation Myocardial Infarction—The HIIT-EARLY Randomized Controlled Trial

Eser, Prisca; Trachsel, Lukas; Marcin, Thimo; Herzig, David; Freiburghaus, Irina; Marchi, Stefano de; Zimmermann, Andreas; Schmid, Jean‐Paul; Wilhelm, Matthias

doi:10.3389/fcvm.2022.869501

Cited by 8 publications

(5 citation statements)

References 48 publications

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“…Advanced echocardiography could add key information in this setting with speckle-tracking-echocardiography-derived parameters. Currently, studies on the role of GLS [13][14][15][16][17][18][19] in evaluating the effect of exercise training on myocardial function have shown conflicting data. Moreover, the method is affected by various limitations, such as load dependence and lack of information on metabolic demand.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies documented the positive effect of exercise training on GLS, specifically in patients with arterial hypertension [13,14], recent myocardial infarction [15], or recent ST-segment elevation myocardial infarction (STEMI) and LV ejection fraction > 45% [16]. However, other studies showed conflicting data on the improvement in GLS due to the training program [17,18], as well as in oncological patients undergoing cardio-oncology rehabilitation, suggesting the need for further investigations [19]. On the other hand, noninvasive MW has been poorly studied in the field of cardiac rehabilitation.…”

Section: Of 14mentioning

confidence: 99%

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Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

Perone,

Ancona,

di Stasio

et al. 2023

JCM

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Background: Myocardial work is an innovative echocardiographic tool to assess left ventricular performance. Emerging data have shown the added value of this method for evaluating cardiac function compared to traditional echocardiographic parameters and global longitudinal strain. However, few studies are present in the literature about the role of myocardial work during cardiac rehabilitation. Our aim was to assess the impact of a rehabilitation program on myocardial work indices in patients with preserved left ventricular ejection fraction and after coronary artery bypass grafting. In addition, we assessed the correlation between baseline myocardial work indices and their change after cardiac rehabilitation, establishing an optimal cut-off value to predict the improvement. Methods: An observational, single-center, and prospective study was conducted. We enrolled patients referred to cardiac rehabilitation after coronary artery bypass grafting and with preserved left ventricular ejection fraction. Before and after the cardiac rehabilitation program, a comprehensive patient assessment was performed, including traditional transthoracic echocardiography, myocardial work analysis, and a six-minute walk test. Results: Eighty-four patients were enrolled; the mean age was 67.96 (±7.42) years and 78.6% were male. The left ventricular ejection fraction was preserved in all patients, and the global longitudinal strain was −16.18 ± 2.55%, the global work index was 1588.56 ± 345 mmHg%, the global constructive work was 1771.27 ± 366.36 mmHg%, the global wasted work was 105.8 ± 72.02 mmHg%, and the global work efficiency was 92.63 ± 3.9% at baseline. After the cardiac rehabilitation program, the global work index, the global constructive work, and the six-minute walk test improved significantly (1588.56 ± 345 vs. 1960.2 ± 377.03 mmHg%, p-value < 0.001; 1771.27 ± 366.36 vs. 2172.01 ± 418.73 mmHg%, p-value < 0.001; 70.71 ± 40.2 vs. 437.5 ± 108.70 m, p-value < 0.001, respectively). Conclusions: Myocardial work indices, specifically global work index and global constructive work, improve after cardiac rehabilitation program in patients undergoing coronary artery bypass grafting with preserved left ventricular ejection fraction.

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Section: Discussionmentioning

confidence: 99%

Section: Of 14mentioning

confidence: 99%

Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

Perone,

Ancona,

di Stasio

et al. 2023

JCM

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“…The bins range from the first quartile to the third quartile, a distance also known as the interquartile range (IQR). The boxplot notch represents the confidence interval around the median, which is usually based on the median ±1.58 * IQR/ √ n and gives a 95% confidence level (Eser et al 2022). If the boxplot notches for the CVs of the two groups do not overlap (Zhang et al 2022), then the CV distributions for all ECGs in that lead can be considered to be significantly different and statistically significant.…”

Section: C_twa Feature Statistical Analysismentioning

confidence: 99%

Myocardial infarction detection method based on the continuous T-wave area feature and multi-lead-fusion deep features

Jiang,

Bian,

Zhang

et al. 2024

Physiol. Meas.

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Objective: Myocardial infarction (MI) is one of the most threatening cardiovascular diseases. This paper aims to explore a method for using an algorithm to autonomously classify myocardial infarction based on the electrocardiogram (ECG). Approach: A detection method of MI that fuses continuous T-wave area (C_TWA) feature and ECG deep features is proposed. This method consists of three main parts: (1) The onset of MI is often accompanied by changes in the shape of the T-wave in the ECG, thus the area of the T-wave displayed on different heartbeats will be quite different. The adaptive sliding window method is used to detect the start and end of the T-wave, and calculate the C_TWA on the same ECG record. Additionally, the coefficient of variation (CV) of C_TWA is defined as the C_TWA feature of the ECG. (2) The multi lead fusion convolutional neural network (Multi-lead-fusion CNN) was implemented to extract the deep features of the ECG. (3) The C_TWA feature and deep features of the ECG were fused by soft attention, and then inputted into the multi-layer perceptron to obtain the detection result. Results: According to the interpatient paradigm, the proposed method reached a 97.67% accuracy, 96.59% precision, and 98.96% recall on the PTB dataset, whereas the proposed method reached 93.15% accuracy, 93.20% precision, and 95.14% recall on the clinical dataset. Significance: The proposed method accurately extracts the feature of the C_TWA, and combines the deep features of the signal, thereby improving the detection accuracy and achieving ideal results on clinical datasets.

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“…While HIIT improves echocardiographic parameters, myocardial work efficiency, and strain measures, 216 the HIIT-EARLY randomized controlled trial observed a long-term worsening of GLS in optimally-treated patients after acute STEMI, with no significant differences in cardiac RR compared to moderate-intensity continuous training. 217 Conversely, moderate-intensity exercise training yields substantial benefits, enhancing exercise capacity without fluctuations in LV end-diastolic diameter (LVEDD), as evidenced in a 3-month programme post-AMI. 218 219 Although LV volume regression was absent, moderate-intensity treadmill training post-MI after successful primary PCI improved LV systolic function, regional function, and exercise capacity.…”

Section: Post-ischaemic Reverse Remodelling and Cardiac Rehabilitationmentioning

confidence: 99%

“…However, the efficacy of high‐intensity interval training (HIIT) compared to moderate‐intensity continuous training remains debatable. While HIIT improves echocardiographic parameters, myocardial work efficiency, and strain measures, 216 the HIIT‐EARLY randomized controlled trial observed a long‐term worsening of GLS in optimally‐treated patients after acute STEMI, with no significant differences in cardiac RR compared to moderate‐intensity continuous training 217 . Conversely, moderate‐intensity exercise training yields substantial benefits, enhancing exercise capacity without fluctuations in LV end‐diastolic diameter (LVEDD), as evidenced in a 3‐month programme post‐AMI 218 .…”

Section: Interventions That Trigger Reverse Remodellingmentioning

confidence: 99%

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

Falcão‐Pires,

Ferreira,

Trindade

et al. 2024

European J of Heart Fail

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Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD‐induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin–angiotensin–aldosterone system inhibitors, beta‐blockers, diuretics and sodium–glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end‐diastolic/end‐systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre‐clinical evaluation.

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Short- and Long-Term Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Left Ventricular Remodeling in Patients Early After ST-Segment Elevation Myocardial Infarction—The HIIT-EARLY Randomized Controlled Trial

Cited by 8 publications

References 48 publications

Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

Myocardial infarction detection method based on the continuous T-wave area feature and multi-lead-fusion deep features

Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function

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