Effect of exercise training on left ventricular mechanics after acute myocardial infarction - an exploratory study

Gordon McGregor; Eric J Stöhr; David Oxborough; Peter Kimani; Rob Shave

doi:10.1016/j.rehab.2018.01.003

Effect of exercise training on left ventricular mechanics after acute myocardial infarction - an exploratory study

Gordon McGregor, Eric J Stöhr, David Oxborough, Peter Kimani, Rob Shave

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Abstract

BACKGROUND: cardiac rehabilitation (CR) exercise training is beneficial after myocardial infarction (MI). Whilst the peripheral adaptations to training are well defined, little is known regarding the effect on left ventricular (LV) remodelling, particularly LV function. Efficient LV ejection and filling is achieved through deformation and rotation of the myocardium in systole and diastole - LV mechanics. The response of LV mechanics to CR exercise training in MI patients is unknown.

METHODS: in this observational exploratory study, 36 (of 40 enrolled) male, MI patients completed either 10-weeks of twice-weekly gym based cardiovascular exercise at 60-80% VO2peak (n=18), or a non-exercise control period (n=18). Cardiopulmonary exercise testing and speckle tracking echocardiography were performed at baseline and 10 weeks.

RESULTS: compared to the non-exercise group, VO2peak improved with CR exercise training (Difference: +4.28 [95% CI, 1.34 to 7.23] ml.kg-1.min-1, P=0.01). Neither conventional LV structural or functional indices, nor LV global longitudinal strain, significantly changed in either group. In contrast, LV twist and twist velocity decreased in the exercise group and increased in the non-exercise group (Difference: -3.95° [95% CI, -7.92 to 0.03°], P=0.05 and -19.2°.sec-1 [95% CI, -35.9 to -2.7°.sec-1], P=0.02, respectively).

CONCLUSION: in MI patients who completed CR exercise training, LV twist and twist velocity decreased, whereas these parameters increased in patients who did not exercise. These preliminary data may indicate reverse LV functional remodelling and improved functional reserve. The assessment of LV twist may serve as an indicator of the therapeutic benefit of CR exercise training and should be investigated in larger trials.

Original language	English
Pages (from-to)	119-124
Number of pages	6
Journal	Annals of Physical and Rehabilitation Medicine
Volume	61
Issue number	3
Early online date	30 Jan 2018
DOIs	https://doi.org/10.1016/j.rehab.2018.01.003
Publication status	Published - May 2018

Bibliographical note

NOTICE: this is the author’s version of a work that was accepted for publication in Annals of Physical and Rehabilitation Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Annals of Physical and Rehabilitation Medicine, [[61], [3], (2018)] DOI: 10.1016/j.rehab.2018.01.003

© 2018, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

Keywords

Left ventricular remodelling
Left ventricular twist
Longitudinal strain

ASJC Scopus subject areas

Orthopedics and Sports Medicine
Rehabilitation

Access to Document

10.1016/j.rehab.2018.01.003

Post-PrintAccepted author manuscript, 765 KBLicence: CC BY-NC-ND

Cite this

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title = "Effect of exercise training on left ventricular mechanics after acute myocardial infarction - an exploratory study",

abstract = "BACKGROUND: cardiac rehabilitation (CR) exercise training is beneficial after myocardial infarction (MI). Whilst the peripheral adaptations to training are well defined, little is known regarding the effect on left ventricular (LV) remodelling, particularly LV function. Efficient LV ejection and filling is achieved through deformation and rotation of the myocardium in systole and diastole - LV mechanics. The response of LV mechanics to CR exercise training in MI patients is unknown.METHODS: in this observational exploratory study, 36 (of 40 enrolled) male, MI patients completed either 10-weeks of twice-weekly gym based cardiovascular exercise at 60-80% VO2peak (n=18), or a non-exercise control period (n=18). Cardiopulmonary exercise testing and speckle tracking echocardiography were performed at baseline and 10 weeks.RESULTS: compared to the non-exercise group, VO2peak improved with CR exercise training (Difference: +4.28 [95% CI, 1.34 to 7.23] ml.kg-1.min-1, P=0.01). Neither conventional LV structural or functional indices, nor LV global longitudinal strain, significantly changed in either group. In contrast, LV twist and twist velocity decreased in the exercise group and increased in the non-exercise group (Difference: -3.95° [95% CI, -7.92 to 0.03°], P=0.05 and -19.2°.sec-1 [95% CI, -35.9 to -2.7°.sec-1], P=0.02, respectively).CONCLUSION: in MI patients who completed CR exercise training, LV twist and twist velocity decreased, whereas these parameters increased in patients who did not exercise. These preliminary data may indicate reverse LV functional remodelling and improved functional reserve. The assessment of LV twist may serve as an indicator of the therapeutic benefit of CR exercise training and should be investigated in larger trials.",

keywords = "Left ventricular remodelling, Left ventricular twist, Longitudinal strain",

author = "Gordon McGregor and St{\"o}hr, {Eric J} and David Oxborough and Peter Kimani and Rob Shave",

note = "NOTICE: this is the author{\textquoteright}s version of a work that was accepted for publication in Annals of Physical and Rehabilitation Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Annals of Physical and Rehabilitation Medicine, [[61], [3], (2018)] DOI: 10.1016/j.rehab.2018.01.003 {\textcopyright} 2018, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ ",

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doi = "10.1016/j.rehab.2018.01.003",

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T1 - Effect of exercise training on left ventricular mechanics after acute myocardial infarction - an exploratory study

AU - McGregor, Gordon

AU - Stöhr, Eric J

AU - Oxborough, David

AU - Kimani, Peter

AU - Shave, Rob

N1 - NOTICE: this is the author’s version of a work that was accepted for publication in Annals of Physical and Rehabilitation Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Annals of Physical and Rehabilitation Medicine, [[61], [3], (2018)] DOI: 10.1016/j.rehab.2018.01.003 © 2018, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

PY - 2018/5

Y1 - 2018/5

N2 - BACKGROUND: cardiac rehabilitation (CR) exercise training is beneficial after myocardial infarction (MI). Whilst the peripheral adaptations to training are well defined, little is known regarding the effect on left ventricular (LV) remodelling, particularly LV function. Efficient LV ejection and filling is achieved through deformation and rotation of the myocardium in systole and diastole - LV mechanics. The response of LV mechanics to CR exercise training in MI patients is unknown.METHODS: in this observational exploratory study, 36 (of 40 enrolled) male, MI patients completed either 10-weeks of twice-weekly gym based cardiovascular exercise at 60-80% VO2peak (n=18), or a non-exercise control period (n=18). Cardiopulmonary exercise testing and speckle tracking echocardiography were performed at baseline and 10 weeks.RESULTS: compared to the non-exercise group, VO2peak improved with CR exercise training (Difference: +4.28 [95% CI, 1.34 to 7.23] ml.kg-1.min-1, P=0.01). Neither conventional LV structural or functional indices, nor LV global longitudinal strain, significantly changed in either group. In contrast, LV twist and twist velocity decreased in the exercise group and increased in the non-exercise group (Difference: -3.95° [95% CI, -7.92 to 0.03°], P=0.05 and -19.2°.sec-1 [95% CI, -35.9 to -2.7°.sec-1], P=0.02, respectively).CONCLUSION: in MI patients who completed CR exercise training, LV twist and twist velocity decreased, whereas these parameters increased in patients who did not exercise. These preliminary data may indicate reverse LV functional remodelling and improved functional reserve. The assessment of LV twist may serve as an indicator of the therapeutic benefit of CR exercise training and should be investigated in larger trials.

AB - BACKGROUND: cardiac rehabilitation (CR) exercise training is beneficial after myocardial infarction (MI). Whilst the peripheral adaptations to training are well defined, little is known regarding the effect on left ventricular (LV) remodelling, particularly LV function. Efficient LV ejection and filling is achieved through deformation and rotation of the myocardium in systole and diastole - LV mechanics. The response of LV mechanics to CR exercise training in MI patients is unknown.METHODS: in this observational exploratory study, 36 (of 40 enrolled) male, MI patients completed either 10-weeks of twice-weekly gym based cardiovascular exercise at 60-80% VO2peak (n=18), or a non-exercise control period (n=18). Cardiopulmonary exercise testing and speckle tracking echocardiography were performed at baseline and 10 weeks.RESULTS: compared to the non-exercise group, VO2peak improved with CR exercise training (Difference: +4.28 [95% CI, 1.34 to 7.23] ml.kg-1.min-1, P=0.01). Neither conventional LV structural or functional indices, nor LV global longitudinal strain, significantly changed in either group. In contrast, LV twist and twist velocity decreased in the exercise group and increased in the non-exercise group (Difference: -3.95° [95% CI, -7.92 to 0.03°], P=0.05 and -19.2°.sec-1 [95% CI, -35.9 to -2.7°.sec-1], P=0.02, respectively).CONCLUSION: in MI patients who completed CR exercise training, LV twist and twist velocity decreased, whereas these parameters increased in patients who did not exercise. These preliminary data may indicate reverse LV functional remodelling and improved functional reserve. The assessment of LV twist may serve as an indicator of the therapeutic benefit of CR exercise training and should be investigated in larger trials.

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Effect of exercise training on left ventricular mechanics after acute myocardial infarction - an exploratory study

Abstract

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