The role of a structured exercise training program on cardiac structure and function after acute myocardial infarction: study protocol for a randomized controlled trialReportar como inadecuado




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Trials

, 16:90

First Online: 12 March 2015Received: 04 September 2014Accepted: 18 February 2015DOI: 10.1186-s13063-015-0612-6

Cite this article as: Fontes-Carvalho, R., Sampaio, F., Teixeira, M. et al. Trials 2015 16: 90. doi:10.1186-s13063-015-0612-6

Abstract

BackgroundExercise training is effective in improving functional capacity and quality of life in patients with coronary artery disease, but its effects on left ventricular systolic and diastolic function are controversial. Diastolic dysfunction is a major determinant of adverse outcome after myocardial infarction and, contrary to systolic function, no therapy or intervention has proved to significantly improve diastolic function. Data from animal studies and from patients with diastolic heart failure has suggested that exercise training can have a positive effect on diastolic function parameters.

This trial aims to evaluate if a structured exercise training program can improve resting left ventricular diastolic and systolic function in patients who have had an acute myocardial infarction.

Methods-DesignThis is a phase II, prospective, randomized, open-label, blinded-endpoint trial that will include at least 96 consecutive patients who have had an acute myocardial infarction one month previously. Patients will be randomized 1:1 to an exercise training program or a control group, receiving standard of care. At enrolment, and at the end of the follow-up period, patients will be submitted to an echocardiography with detailed assessment of diastolic and systolic function using recent consensus guidelines, cardiopulmonary exercise testing, an anthropometric assessment, blood testing, and clinical evaluation. Patients randomized to the intervention group will be submitted to an eight-week outpatient exercise program, combining endurance and resistance training, for three sessions per week. The primary endpoint will be the change in lateral E’ velocity immediately after the eight-week exercise training program. Secondary endpoints will include other echocardiographic parameters of left ventricular diastolic and systolic function, cardiac structure, metabolic and inflammation biomarkers high-sensitivity C-reactive protein and pro-BNP, functional capacity peak oxygen consumption and anaerobic threshold and anthropometric measurements.

DiscussionNew strategies that can improve left ventricular diastolic function are clinically needed. This will be the first trial to evaluate, in patients who have had an acute myocardial infarction, the effects of a structured program of exercise training on diastolic and systolic function, assessed by novel echocardiographic parameters.

Trial registrationRegistered with ClinicalTrials.gov reference: NCT02224495 on 21 August 2014.

KeywordsDiastole Systole Exercise therapy Myocardial infarction AbbreviationsAMIAcute myocardial infarction

ASEAmerican Society of Echocardiography

ATAnaerobic threshold

BMIBody mass index

BNPBrain Natriuretic Peptide

DDDiastolic dysfunction

DTDeceleration time

EAEEuropean Association of Echocardiography

IVRTIsovolumetric relaxation time

HOMA-IRHomeostasis Model Assessment of Insulin Resistance

pVO2Peak oxygen consumption

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Autor: Ricardo Fontes-Carvalho - Francisco Sampaio - Madalena Teixeira - Vasco Gama - Adelino F Leite-Moreira

Fuente: https://link.springer.com/



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