Metabolic Adaptation during Cardiac Exercise Rehabilitation in Patients after a First Myocardial Infarction.

Area of Science:

• Cardiology
• Metabolomics
• Exercise Physiology

Background:

• Cardiac rehabilitation (CR) is crucial for post-myocardial infarction (MI) recovery.
• The metabolic and lipidomic effects of intensive CR programs require further investigation.

Purpose of the Study:

• To investigate metabolic and lipidomic adaptations in non-diabetic male patients after ST-elevation MI (STEMI) undergoing an intensive CR program.
• To explore potential biomarkers and mechanisms underlying CR benefits.

Main Methods:

• 25 non-diabetic male patients (<75 years) post-STEMI participated in 24 ± 3 CR sessions.
• Clinical assessments, B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF%), C-reactive protein (CRP), and homocysteine levels were measured.
• Metabolomics and lipidomics analysis of dried blood spots (DBS) were performed in a subgroup (n=17).

Main Results:

• CR improved clinical outcomes: 6 min walk test, BNP, LVEF%, CRP, and homocysteine.
• Metabolomic analysis revealed sustained adaptations, including increased N-acetyl-l-tyrosine (NAT), suggesting mitohormesis.
• Lipidome showed an acute response to initial training with upregulated phosphatidylserines (PS), linked to PSS1 activity.

Conclusions:

• Intensive CR induces significant metabolic and lipidomic adaptations in post-STEMI patients.
• Findings suggest mitohormesis as a potential mechanism for CR benefits.
• Identified metabolic pathways and biomarkers warrant further research in controlled studies.