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Effect of high-intensity interval training on progression of cardiac allograft vasculopathy
Kari Nytrøen1, Lene Annette Rustad, Ingrid Erikstad
1Department of Cardiology, Oslo University Hospital HF Rikshospitalet, Oslo.
Insights
High-intensity interval training (HIIT) significantly slowed cardiac allograft vasculopathy (CAV) progression in heart transplant recipients. This exercise intervention shows promise for managing CAV, a major cause of heart transplant failure.
Area of Science:
- Cardiology
- Transplantation Medicine
- Exercise Physiology
Background:
- Cardiac allograft vasculopathy (CAV) is a leading cause of heart transplant failure.
- Current management strategies for CAV are limited.
Purpose of the Study:
- To investigate the efficacy of high-intensity interval training (HIIT) in mitigating CAV progression.
- To evaluate the impact of HIIT on atheroma volume and intimal thickness in heart transplant recipients.
Main Methods:
- Randomized controlled trial involving 43 heart transplant recipients.
- Intervention group received 1 year of HIIT; control group received standard care.
- Intravascular ultrasound (IVUS) was used to assess CAV progression.
Main Results:
- HIIT group showed a significantly smaller increase in plaque atheroma volume (PAV) compared to controls (0.9% vs 2.5%, p=0.021).
- Mean increase in total atheroma volume (TAV) was significantly lower in the HIIT group (0.3 vs 1.1 mm³/mm, p=0.020).
- Mean increase in maximal intimal thickness (MIT) approached significance in the HIIT group (p=0.054).
Conclusions:
- HIIT effectively reduces the rate of CAV progression in stable heart transplant recipients.
- Exercise rehabilitation, specifically HIIT, may be a valuable addition to CAV management protocols.
- Larger studies are warranted to confirm these findings and optimize exercise strategies.
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] mm(3)/mm in the HIT group vs 1.1 [0.6 to 1.7] mm(3)/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.
