Effect of high-intensity interval training on progression of cardiac allograft vasculopathy

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Background

Cardiac allograft vasculopathy (CAV) is a progressive form of atherosclerosis occurring in heart transplant (HTx) recipients, leading to increased morbidity and mortality. Given the atheroprotective effect of exercise on traditional atherosclerosis, we hypothesized that high-intensity interval training (HIIT) would reduce the progression of CAV among HTx recipients.

Methods

Forty-three cardiac allograft recipients (mean ± SD age 51 ± 16 years; 67% men; time post-HTx 4.0 ± 2.2 years), all clinically stable and >18 years old, were randomized to either a HIIT group or control group (standard care) for 1 year. The effect of training on CAV progression was assessed by intravascular ultrasound (IVUS).

Results

IVUS analysis revealed a significantly smaller mean increase [95% CI] in atheroma volume (PAV) of 0.9% [95% CI -;0.3% to 1.9%] in the HIIT group as compared with the control group, 2.5% [1.6% to 3.5%] (p = 0.021). Similarly, the mean increase in total atheroma volume (TAV) was 0.3 [0.0 to 0.6] mm3/mm in the HIT group vs 1.1 [0.6 to 1.7] mm3/mm in the control group (p = 0.020), and mean increase in maximal intimal thickness (MIT) was 0.02−0.01 to 0.04] mm in the HIIT group vs 0.05 [0.03 to 0.08] mm in the control group (p = 0.054). Qualitative plaque progression (virtual histology parameters) and inflammatory activity (biomarkers) were similar between the 2 groups during the study period.

Conclusions

HIIT among maintenance HTx recipients resulted in a significantly impaired rate of CAV progression. Future larger studies should address whether exercise rehabilitation strategies should be included in CAV management protocols.

Section snippets

Patients and settings

Briefly, we prospectively recruited 57 clinically stable HTx patients from a cohort of 192 potential participants during their annual follow-up between 2009 and 2010 (Figure 1). The inclusion criteria were: age >18 years; 1 to 8 years after HTx; optimal medical treatment; stable clinical condition; ability to perform maximal exercise test on a treadmill; willingness and ability to perform a 1-year HIIT program, not far from their home; and provision of written informed consent. Exclusion

Results

The study population (Figure 1) has been described previously.13 For the total sample (n = 43) the mean age was 52 ± 16 (range 19 to 71) years, 67% were men, and the mean time after HTx was 4.0 ± 2.2 years. Baseline clinical characteristics are shown in Table 1, with no differences between the HIIT and the control group.

Discussion

Prevention and treatment of CAV is a major clinical challenge in the management of patients after HTx. We have previously shown that HIIT allows for significantly greater improvement in functional exercise capacity as measured by VO2peak in HTx recipients. To the best of our knowledge, the present study was the first to show that HIIT, among stable HTx recipients, results in a significantly impaired rate of quantitative CAV progression, as assessed by IVUS. Our findings further suggest that,

Disclosure statement

The authors have no conflicts of interest to disclose.

We thank the HTx nurses, Anne Relbo and Ingelin Grov, for their genuine interest in the project and their professional and practical help.

This work was funded by a grant from the South-East Health Region in Norway (Helse Sør-Øst) and further supported by a gift from an anonymous benefactor.

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