Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy.
Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy.
Medicina (Kaunas). 2022 Mar 21;58(3):453. doi: 10.3390/medicina58030453.
Background andObjectives: Current guidelines on cardiac rehabilitation (CR) suggest moderate-intensity physical activity after acute coronary syndrome (ACS). Recent report have shown that high-intensity interval training (HIIT) could be more effective than moderate-intensity continuous training (MCT) in improving cardiac performance. Our aim was to analyze the effects of HIIT protocol after ACS on advanced echocardiographic parameters of myocardial function. Materials and Methods: In total, 75 patients with recent ACS, with or without ST segment elevation, were enrolled and compared with a control group of 50 age- and sex-comparable healthy subjects. Patients were randomized to perform a MCT training or HIIT-based rehabilitation program. A complete echocardiographic evaluation, including left ventricular (LV) and left atrial (LA) global longitudinal strain (GLS) and myocardial work (MW) through speckle-tracking analysis, was performed for all patients, before and after cardiac rehabilitation training. A cardiopulmonary exercise testing (CPET) was also performed at the end of the rehabilitation program. Results: Patients who followed the HIIT rehabilitation program showed improved LV diastolic function compared to the MCT group (E/e’: 3.4 ± 3.1 vs. 6.4 ± 2.8, respectively, p < 0.01). Similarly, LV systolic function showed significant improvement in the group of patients performing HIIT (ejection fraction: 53.1 ± 6.4 vs. 52.3 ± 5.4%, p < 0.01; GLS: −17.8 ± 3.8 vs. −15.4 ± 4.3, p < 0.01). In addition, LA strain was improved. MW efficiency was also increased in the HIIT group (91.1 ± 3.3 vs. 87.4 ± 4.1%, p < 0.01), and was closely related to peak effort measurements expressed in peak VO2 by CPET. Conclusions: In patients with recent ACS, the HIIT rehabilitation program determined reverse cardiac remodeling, with the improvement of diastolic and systolic function, assessed by standard echocardiography. In addition, cardiac deformation index as GLS, LA strain and MW efficiency improved significantly after HIIT, and were associated with functional capacity during effort.
目前关于心脏康复的指南建议急性冠状动脉综合征（ACS）后进行中等强度的体力活动。最近的报告表明，高强度间歇训练（HIIT）比中等强度持续训练（MCT）更能有效改善心脏功能。我们的目的是分析 ACS 后 HIIT 方案对心肌功能的先进超声心动图参数的影响。
共有 75 例近期 ACS 患者（包括 ST 段抬高型和非 ST 段抬高型）入组，与 50 例年龄和性别相匹配的健康对照组进行比较。患者被随机分为进行 MCT 训练或基于 HIIT 的康复方案。对所有患者进行完整的超声心动图评估，包括左心室（LV）和左心房（LA）整体纵向应变（GLS）和心肌做功（MW）的斑点追踪分析，在心脏康复训练前后进行。在康复计划结束时还进行了心肺运动测试（CPET）。
与 MCT 组相比，接受 HIIT 康复方案的患者 LV 舒张功能得到改善（E/e'：3.4 ± 3.1 对 6.4 ± 2.8，p < 0.01）。同样，进行 HIIT 的患者 LV 收缩功能也有显著改善（射血分数：53.1 ± 6.4 对 52.3 ± 5.4%，p < 0.01；GLS：-17.8 ± 3.8 对-15.4 ± 4.3，p < 0.01）。此外，LA 应变也得到改善。HIIT 组 MW 效率也增加（91.1 ± 3.3 对 87.4 ± 4.1%，p < 0.01），与 CPET 中以峰值 VO2 表示的峰值努力测量密切相关。
在近期 ACS 患者中，HIIT 康复方案通过标准超声心动图评估，确定了逆转心脏重构，改善舒张和收缩功能。此外，HIIT 后 GLS、LA 应变和 MW 效率等心脏变形指数显著改善，并与努力时的功能能力相关。
