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Short- and long-term effects of high-intensity interval training versus moderate-intensity continuous training on left ventricular remodeling in patients early after ST-segment elevation myocardial infarction-the HIIT-EARLY randomized controlled trial |
Eser P, Trachsel LD, Marcin T, Herzig D, Freiburghaus I, De Marchi S, Zimmermann AJ, Schmid JP, Wilhelm M |
Frontiers in Cardiovascular Medicine 2022 Jun 17;9(869501):Epub |
clinical trial |
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
AIM: Due to insufficient evidence on the safety and effectiveness of high-intensity interval training (HIIT) in patients early after ST-segment elevation myocardial infarction (STEMI), we aimed to compare short- and long-term effects of randomized HIIT or moderate-intensity continuous training (MICT) on markers of left ventricular (LV) remodeling in STEMI patients receiving optimal guideline-directed medical therapy (GDMT). MATERIALS AND METHODS: Patients after STEMI (< 4 weeks) enrolled in a 12-week cardiac rehabilitation (CR) program were recruited for this randomized controlled trial (NCT02627586). During a 3-week run-in period with three weekly MICT sessions, GDMT was up-titrated. Then, the patients were randomized to HIIT or isocaloric MICT for 9 weeks. Echocardiography and cardiopulmonary exercise tests were performed after run-in (3 weeks), end of CR (12 weeks), and at 1-year follow-up. The primary outcome was LV end-diastolic volume index (LVEDVi) at the end of CR. Secondary outcomes were LV global longitudinal strain (GLS) and cardiopulmonary fitness. RESULTS: Seventy-three male patients were included, with the time between STEMI and start of CR and randomization being 12.5 +/- 6.3 and 45.8 +/- 10.8 days, respectively. Mixed models revealed no significant group x time interaction for LVEDVi at the end of CR (p = 0.557). However, there was a significantly smaller improvement in GLS at 1-year follow-up in the HIIT compared to the MICT group (p = 0.031 for group x time interaction). Cardiorespiratory fitness improved significantly from a median value of 26.5 (1st quartile 24.4; 3rd quartile 1.1) ml/kg/min at randomization in the HIIT and 27.7 (23.9 to 31.6) ml/kg/min in the MICT group to 29.6 (25.3 to 32.2) and 29.9 (26.1 to 34.9) ml/kg/min at the end of CR and to 29.0 (26.6 to 33.3) and 30.6 (26.0 to 33.8) ml/kg/min at 1 year follow-up in HIIT and MICT patients, respectively, with no significant group x time interactions (p = 0.138 and 0.317). CONCLUSION: In optimally treated patients early after STEMI, HIIT was not different from isocaloric MICT with regard to short-term effects on LVEDVi and cardiorespiratory fitness. The worsening in GLS at 1 year in the HIIT group deserves further investigation, as early HIIT may offset the beneficial effects of GDMT on LV remodeling in the long term.
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