BACKGROUND: Increase of exercise capacity (peak VO2) after cardiac rehabilitation improves outcome in patients with coronary artery disease (CAD). Systolic and diastolic function have been associated with peak VO2, but their role towards improvement of exercise capacity remains unclear. It is unknown which exercise intensity has the most beneficial impact on left ventricular (LV) geometry and function in CAD patients without heart failure. METHODS: 200 stable CAD patients without heart failure were randomized to 3 months of aerobic interval training (AIT) or aerobic continuous training (ACT). Cardiopulmonary exercise test and transthoracic echocardiography were scheduled before and after 3 months of training. RESULTS: At baseline, a higher peak VO2 correlated with lower LV posterior wall thickness (p = 0.002), higher LV ejection fraction (p = 0.008), better LV global longitudinal strain (p = 0.043) and lower E/e' (p = 0.001). After multivariate stepwise regression analysis only E/e remained an independent predictor of peak VO2 (p = 0.042). Improvement of peak VO2 after 3 months of training correlated with reverse remodeling of the interventricular septum (p = 0.005), enlargement of LV diastolic volume (p = 0.007) and increase of LV stroke volume (p = 0.018) but not with other indices of systolic or diastolic function. Significant reduction of the interventricular septum thickness after cardiac rehabilitation was observed (p = 0.012), with a trend towards more reverse remodeling after ACT compared to AIT (p = 0.054). In contrast, there were no changes in other parameters of LV geometry, diastolic or systolic function. CONCLUSION: Systolic and diastolic function are determinants of baseline exercise capacity in CAD patients without heart failure, but do not seem to mediate improvement of peak VO2 after either AIT or ACT.

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