Reverse left ventricular remodelling – effect of cardiac ...
Reverse left ventricular remodeling: effect of cardiac rehabilitation exercise training in myocardial infarction patients with preserved ejection fractionSHORT TITLE: CR EXERCISE TRAINING AND REVERSE LV REMODELINGG. MCGREGOR 1, 2, D. GAZE 3, D. OXBOROUGH 4 , J. O’DRISCOLL 5, R. SHAVE 11Cardiff Metropolitan University, Cardiff, UK 2University Hospital, Coventry, UK 3St George’s Hospital, London, UK 4Liverpool John Moore’s University, Liverpool, UK 5Canterbury Christchurch University, Canterbury, UKCorresponding author: G. McGregor, Cardiac Rehabilitation, 1st Floor, East Wing, University Hospital, Coventry, CV2 2DX, England. E-mail: gordon.mcgregor@uhcw.nhs.ukBackground. In the increasingly prevalent population of postmyocardial infarction (MI) patients with preserved left ventricular (LV) ejection fraction (>45%), the effect of cardiac rehabilitation (CR) exercise training on LV structure and function is unknown. Aim. To examine the reverse LV remodeling effect of CR exercise training in post-MI patients with preserved LV ejection fraction (>45%).Design. Prospective, longitudinal, controlled trial.Setting. Outpatient CR programme.Population. Fifty six asymptomatic, post-MI patients without residual myocardial ischemia and LV ejection fraction >45%.Methods. Within 3-6 weeks of MI, and 10 weeks later, echocardiography and cardiopulmonary exercise testing were performed. An exercise training group (N.=36) completed twice weekly gym based cardiovascular exercise (60-80% VO2 peak) and a resistance training programme, whilst a non-exercise group (N.=20) did not. Results. In comparison to the non-exercise group, in which there was no change, 10 weeks of CR exercise training resulted in increased VO2peak and reduced LV end diastolic and systolic volumes (all P<0.05 vs. non-exercise group). Conclusion. In post-MI patients with preserved LV ejection fraction (>45%), CR exercise training is effective in improving functional capacity and reducing LV volumes. Clinical Rehabilitation Impact. In this previously unstudied population, the measurement of reverse LV volumetric remodeling may prove useful as an indicator of CR exercise programme efficacy. To maximize the potential clinical benefit from reverse LV remodeling, this patient group, should be actively encouraged to engage in CR exercise training.Key words: Rehabilitation - HYPERLINK "" Exercise Test - Myocardial infarction - Ventricular Remodeling.Myocardial infarction (MI) is associated with molecular disarray, myocyte hypertrophy and extra-cellular matrix degradation. ADDIN EN.CITE <EndNote><Cite><Author>Mann</Author><Year>2010</Year><RecNum>1320</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>1320</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s">1320</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mann, D. L.</author><author>Bogaev, R.</author><author>Buckberg, G. D.</author></authors></contributors><auth-address>Division of Cardiology, Department of Medicine, Washington University, St Louis, MO 63110, USA.</auth-address><titles><title>Cardiac remodelling and myocardial recovery: lost in translation?</title><secondary-title>Eur J Heart Fail</secondary-title></titles><periodical><full-title>Eur J Heart Fail</full-title></periodical><pages>789-96</pages><volume>12</volume><number>8</number><edition>2010/08/03</edition><keywords><keyword>Decision Making</keyword><keyword>Disease Progression</keyword><keyword>Health Status Indicators</keyword><keyword>Heart Failure/diagnosis/*physiopathology</keyword><keyword>Humans</keyword><keyword>Myocardium/*pathology</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword><keyword>Stroke Volume</keyword><keyword>Ventricular Function, Left</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2010</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1879-0844 (Electronic)
1388-9842 (Linking)</isbn><accession-num>20675667</accession-num><urls><related-urls><url> [pii]
10.1093/eurjhf/hfq113</electronic-resource-num><language>eng</language></record></Cite></EndNote>1 This results in pathologically increased left ventricular (LV) mass and volume and altered LV geometry. ADDIN EN.CITE <EndNote><Cite><Author>Mann</Author><Year>2010</Year><RecNum>1320</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>1320</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s">1320</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mann, D. L.</author><author>Bogaev, R.</author><author>Buckberg, G. D.</author></authors></contributors><auth-address>Division of Cardiology, Department of Medicine, Washington University, St Louis, MO 63110, USA.</auth-address><titles><title>Cardiac remodelling and myocardial recovery: lost in translation?</title><secondary-title>Eur J Heart Fail</secondary-title></titles><periodical><full-title>Eur J Heart Fail</full-title></periodical><pages>789-96</pages><volume>12</volume><number>8</number><edition>2010/08/03</edition><keywords><keyword>Decision Making</keyword><keyword>Disease Progression</keyword><keyword>Health Status Indicators</keyword><keyword>Heart Failure/diagnosis/*physiopathology</keyword><keyword>Humans</keyword><keyword>Myocardium/*pathology</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword><keyword>Stroke Volume</keyword><keyword>Ventricular Function, Left</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2010</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1879-0844 (Electronic)
1388-9842 (Linking)</isbn><accession-num>20675667</accession-num><urls><related-urls><url> [pii]
10.1093/eurjhf/hfq113</electronic-resource-num><language>eng</language></record></Cite></EndNote>1 The process of LV remodeling, characterized by structural maladaptation and functional decline, begins with the onset of acute MI and is chronically driven by systemic neurohormonal activation. ADDIN EN.CITE <EndNote><Cite><Author>Mann</Author><Year>2005</Year><RecNum>1344</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>1344</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s">1344</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mann, D. L.</author><author>Bristow, M. R.</author></authors></contributors><auth-address>Winters Center for Heart Failure Research, Department of Medicine, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. dmann@bcm.tmc.edu</auth-address><titles><title>Mechanisms and models in heart failure: the biomechanical model and beyond</title><secondary-title>Circulation</secondary-title></titles><periodical><full-title>Circulation</full-title></periodical><pages>2837-49</pages><volume>111</volume><number>21</number><edition>2005/06/02</edition><keywords><keyword>Disease Progression</keyword><keyword>Heart Failure/*etiology/pathology</keyword><keyword>Humans</keyword><keyword>*Models, Cardiovascular</keyword><keyword>Neurosecretory Systems</keyword><keyword>Receptors, Adrenergic/genetics/metabolism</keyword><keyword>Ventricular Remodeling</keyword></keywords><dates><year>2005</year><pub-dates><date>May 31</date></pub-dates></dates><isbn>1524-4539 (Electronic)
0009-7322 (Linking)</isbn><accession-num>15927992</accession-num><urls><related-urls><url> [pii]
10.1161/CIRCULATIONAHA.104.500546</electronic-resource-num><language>eng</language></record></Cite></EndNote>2 Mortality is linked to the nature and extent of LV remodeling and also to the degree of neurohormonal activation.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WZXJtYTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WZXJtYTwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl
Y051bT4zMzA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4z
LCA0PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MzMwPC9yZWMtbnVt
YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieDV3ZHZ4ejJlZnh0emVlcnBl
dTVkZXAwdDk1enJ6cjJyMDlzIiB0aW1lc3RhbXA9IjEzNTA5ODk4NzgiPjMzMDwva2V5PjwvZm9y
ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48
Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+VmVybWEsIEEuPC9hdXRob3I+PGF1dGhvcj5N
ZXJpcywgQS48L2F1dGhvcj48YXV0aG9yPlNrYWxpLCBILjwvYXV0aG9yPjxhdXRob3I+R2hhbGks
IEouIEsuPC9hdXRob3I+PGF1dGhvcj5Bcm5vbGQsIEouIE0uPC9hdXRob3I+PGF1dGhvcj5Cb3Vy
Z291biwgTS48L2F1dGhvcj48YXV0aG9yPlZlbGF6cXVleiwgRS4gSi48L2F1dGhvcj48YXV0aG9y
Pk1jTXVycmF5LCBKLiBKLjwvYXV0aG9yPjxhdXRob3I+S29iZXIsIEwuPC9hdXRob3I+PGF1dGhv
cj5QZmVmZmVyLCBNLiBBLjwvYXV0aG9yPjxhdXRob3I+Q2FsaWZmLCBSLiBNLjwvYXV0aG9yPjxh
dXRob3I+U29sb21vbiwgUy4gRC48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1
dGgtYWRkcmVzcz5CcmlnaGFtIGFuZCBXb21lbiZhcG9zO3MgSG9zcGl0YWwsIEJvc3RvbiwgTWFz
c2FjaHVzZXR0cyAwMjExNSwgVVNBLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPlByb2du
b3N0aWMgaW1wbGljYXRpb25zIG9mIGxlZnQgdmVudHJpY3VsYXIgbWFzcyBhbmQgZ2VvbWV0cnkg
Zm9sbG93aW5nIG15b2NhcmRpYWwgaW5mYXJjdGlvbjogdGhlIFZBTElBTlQgKFZBTHNhcnRhbiBJ
biBBY3V0ZSBteW9jYXJkaWFsIGlOZmFyY1Rpb24pIEVjaG9jYXJkaW9ncmFwaGljIFN0dWR5PC90
aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkpBQ0MgQ2FyZGlvdmFzYyBJbWFnaW5nPC9zZWNvbmRhcnkt
dGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SkFDQyBDYXJkaW92YXNjIElt
YWdpbmc8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz41ODItOTE8L3BhZ2VzPjx2b2x1
bWU+MTwvdm9sdW1lPjxudW1iZXI+NTwvbnVtYmVyPjxlZGl0aW9uPjIwMDkvMDQvMTA8L2VkaXRp
b24+PGtleXdvcmRzPjxrZXl3b3JkPkFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+QW5naW90ZW5zaW4g
SUkgVHlwZSAxIFJlY2VwdG9yIEJsb2NrZXJzLyp0aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtl
eXdvcmQ+Q2FyZGlvdmFzY3VsYXIgRGlzZWFzZXMvKmV0aW9sb2d5L21vcnRhbGl0eS9wcmV2ZW50
aW9uICZhbXA7IGNvbnRyb2wvdWx0cmFzb25vZ3JhcGh5PC9rZXl3b3JkPjxrZXl3b3JkPkV1cm9w
ZTwva2V5d29yZD48a2V5d29yZD5GZW1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+SGVhcnQgVmVudHJp
Y2xlcy9waHlzaW9wYXRob2xvZ3kvKnVsdHJhc29ub2dyYXBoeTwva2V5d29yZD48a2V5d29yZD5I
dW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+SHlwZXJ0cm9waHksIExlZnQgVmVudHJpY3VsYXIvZXRp
b2xvZ3kvbW9ydGFsaXR5Lyp1bHRyYXNvbm9ncmFwaHk8L2tleXdvcmQ+PGtleXdvcmQ+S2FwbGFu
LU1laWVyIEVzdGltYXRlPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtleXdvcmQ+
TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TXlvY2FyZGlhbCBJbmZhcmN0aW9uLypjb21w
bGljYXRpb25zL2RydWcgdGhlcmFweS9tb3J0YWxpdHkvdWx0cmFzb25vZ3JhcGh5PC9rZXl3b3Jk
PjxrZXl3b3JkPlByZWRpY3RpdmUgVmFsdWUgb2YgVGVzdHM8L2tleXdvcmQ+PGtleXdvcmQ+UHJv
cG9ydGlvbmFsIEhhemFyZHMgTW9kZWxzPC9rZXl3b3JkPjxrZXl3b3JkPlJlY3VycmVuY2U8L2tl
eXdvcmQ+PGtleXdvcmQ+UmlzayBBc3Nlc3NtZW50PC9rZXl3b3JkPjxrZXl3b3JkPlJpc2sgRmFj
dG9yczwva2V5d29yZD48a2V5d29yZD5UZXRyYXpvbGVzLyp0aGVyYXBldXRpYyB1c2U8L2tleXdv
cmQ+PGtleXdvcmQ+VGltZSBGYWN0b3JzPC9rZXl3b3JkPjxrZXl3b3JkPlRyZWF0bWVudCBPdXRj
b21lPC9rZXl3b3JkPjxrZXl3b3JkPlVuaXRlZCBTdGF0ZXM8L2tleXdvcmQ+PGtleXdvcmQ+VmFs
aW5lLyphbmFsb2dzICZhbXA7IGRlcml2YXRpdmVzL3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48
a2V5d29yZD4qVmVudHJpY3VsYXIgUmVtb2RlbGluZzwva2V5d29yZD48L2tleXdvcmRzPjxkYXRl
cz48eWVhcj4yMDA4PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+U2VwPC9kYXRlPjwvcHViLWRhdGVz
PjwvZGF0ZXM+PGlzYm4+MTg3Ni03NTkxIChFbGVjdHJvbmljKTwvaXNibj48YWNjZXNzaW9uLW51
bT4xOTM1NjQ4NTwvYWNjZXNzaW9uLW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDov
L3d3dy5uY2JpLm5sbS5uaWguZ292L2VudHJlei9xdWVyeS5mY2dpP2NtZD1SZXRyaWV2ZSZhbXA7
ZGI9UHViTWVkJmFtcDtkb3B0PUNpdGF0aW9uJmFtcDtsaXN0X3VpZHM9MTkzNTY0ODU8L3VybD48
L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPlMxOTM2LTg3OFgo
MDgpMDAyMjYtWCBbcGlpXSYjeEQ7MTAuMTAxNi9qLmpjbWcuMjAwOC4wNS4wMTI8L2VsZWN0cm9u
aWMtcmVzb3VyY2UtbnVtPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48
Q2l0ZT48QXV0aG9yPk1haXNlbDwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJlY051bT4yMTI8
L1JlY051bT48cmVjb3JkPjxyZWMtbnVtYmVyPjIxMjwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlz
PjxrZXkgYXBwPSJFTiIgZGItaWQ9Ing1d2R2eHoyZWZ4dHplZXJwZXU1ZGVwMHQ5NXpyenIycjA5
cyIgdGltZXN0YW1wPSIxMzQ3MzAzNzA3Ij4yMTI8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5
cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0
aG9ycz48YXV0aG9yPk1haXNlbCwgQS48L2F1dGhvcj48YXV0aG9yPk11ZWxsZXIsIEMuPC9hdXRo
b3I+PGF1dGhvcj5BZGFtcywgSy4sIEpyLjwvYXV0aG9yPjxhdXRob3I+QW5rZXIsIFMuIEQuPC9h
dXRob3I+PGF1dGhvcj5Bc3Byb21vbnRlLCBOLjwvYXV0aG9yPjxhdXRob3I+Q2xlbGFuZCwgSi4g
Ry48L2F1dGhvcj48YXV0aG9yPkNvaGVuLVNvbGFsLCBBLjwvYXV0aG9yPjxhdXRob3I+RGFobHN0
cm9tLCBVLjwvYXV0aG9yPjxhdXRob3I+RGVNYXJpYSwgQS48L2F1dGhvcj48YXV0aG9yPkRpIFNv
bW1hLCBTLjwvYXV0aG9yPjxhdXRob3I+RmlsaXBwYXRvcywgRy4gUy48L2F1dGhvcj48YXV0aG9y
PkZvbmFyb3csIEcuIEMuPC9hdXRob3I+PGF1dGhvcj5Kb3VyZGFpbiwgUC48L2F1dGhvcj48YXV0
aG9yPktvbWFqZGEsIE0uPC9hdXRob3I+PGF1dGhvcj5MaXUsIFAuIFAuPC9hdXRob3I+PGF1dGhv
cj5NY0RvbmFnaCwgVC48L2F1dGhvcj48YXV0aG9yPk1jRG9uYWxkLCBLLjwvYXV0aG9yPjxhdXRo
b3I+TWViYXphYSwgQS48L2F1dGhvcj48YXV0aG9yPk5pZW1pbmVuLCBNLiBTLjwvYXV0aG9yPjxh
dXRob3I+UGVhY29jaywgVy4gRi48L2F1dGhvcj48YXV0aG9yPlR1YmFybywgTS48L2F1dGhvcj48
YXV0aG9yPlZhbGxlLCBSLjwvYXV0aG9yPjxhdXRob3I+VmFuZGVyaHlkZW4sIE0uPC9hdXRob3I+
PGF1dGhvcj5ZYW5jeSwgQy4gVy48L2F1dGhvcj48YXV0aG9yPlphbm5hZCwgRi48L2F1dGhvcj48
YXV0aG9yPkJyYXVud2FsZCwgRS48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1
dGgtYWRkcmVzcz5WQSBTYW4gRGllZ28gSGVhbHRoY2FyZSBTeXN0ZW0gQ2FyZGlvbG9neSwgU2Fu
IERpZWdvLCBDQSA5MjE2MSwgVVNBLiBhbWFpc2VsQHVjc2QuZWR1PC9hdXRoLWFkZHJlc3M+PHRp
dGxlcz48dGl0bGU+U3RhdGUgb2YgdGhlIGFydDogdXNpbmcgbmF0cml1cmV0aWMgcGVwdGlkZSBs
ZXZlbHMgaW4gY2xpbmljYWwgcHJhY3RpY2U8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+RXVyIEog
SGVhcnQgRmFpbDwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRp
dGxlPkV1ciBKIEhlYXJ0IEZhaWw8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz44MjQt
Mzk8L3BhZ2VzPjx2b2x1bWU+MTA8L3ZvbHVtZT48bnVtYmVyPjk8L251bWJlcj48ZWRpdGlvbj4y
MDA4LzA5LzAyPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BbGdvcml0aG1zPC9rZXl3b3Jk
PjxrZXl3b3JkPkJpb2xvZ2ljYWwgTWFya2Vycy8qYmxvb2Q8L2tleXdvcmQ+PGtleXdvcmQ+Q29t
b3JiaWRpdHk8L2tleXdvcmQ+PGtleXdvcmQ+RGlhZ25vc2lzLCBEaWZmZXJlbnRpYWw8L2tleXdv
cmQ+PGtleXdvcmQ+SGVhcnQgRmFpbHVyZS8qZGlhZ25vc2lzPC9rZXl3b3JkPjxrZXl3b3JkPkh1
bWFuczwva2V5d29yZD48a2V5d29yZD5OYXRyaXVyZXRpYyBQZXB0aWRlLCBCcmFpbi8qYmxvb2Q8
L2tleXdvcmQ+PGtleXdvcmQ+UHJhY3RpY2UgR3VpZGVsaW5lcyBhcyBUb3BpYzwva2V5d29yZD48
L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDA4PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+U2VwPC9k
YXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTM4OC05ODQyIChQcmludCkmI3hEOzEzODgt
OTg0MiAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTg3NjA5NjU8L2FjY2Vzc2lvbi1u
dW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9l
bnRyZXovcXVlcnkuZmNnaT9jbWQ9UmV0cmlldmUmYW1wO2RiPVB1Yk1lZCZhbXA7ZG9wdD1DaXRh
dGlvbiZhbXA7bGlzdF91aWRzPTE4NzYwOTY1PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxl
bGVjdHJvbmljLXJlc291cmNlLW51bT5TMTM4OC05ODQyKDA4KTAwMzU0LTEgW3BpaV0mI3hEOzEw
LjEwMTYvai5lamhlYXJ0LjIwMDguMDcuMDE0PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48bGFu
Z3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE.DATA 3, 4 Specifically, increased LV volumes and reduced LV ejection fraction (LVEF) are exponentially related to poor prognosis PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb2xsZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb2xsZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 5 providing a clear rationale to attenuate this process. In post-MI patients, pharmacological and electrophysiological interventions improve cardiovascular and all-cause mortality.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb25zdGFtPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb25zdGFtPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48
UmVjTnVtPjMxMTwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi
PjYsIDc8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4zMTE8L3JlYy1u
dW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4NXdkdnh6MmVmeHR6ZWVy
cGV1NWRlcDB0OTV6cnpyMnIwOXMiIHRpbWVzdGFtcD0iMTM1MDk4OTc3OSI+MzExPC9rZXk+PC9m
b3JlaWduLWtleXM+PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBl
Pjxjb250cmlidXRvcnM+PGF1dGhvcnM+PGF1dGhvcj5Lb25zdGFtLCBNLiBBLjwvYXV0aG9yPjxh
dXRob3I+S3JhbWVyLCBELiBHLjwvYXV0aG9yPjxhdXRob3I+UGF0ZWwsIEEuIFIuPC9hdXRob3I+
PGF1dGhvcj5NYXJvbiwgTS4gUy48L2F1dGhvcj48YXV0aG9yPlVkZWxzb24sIEouIEUuPC9hdXRo
b3I+PC9hdXRob3JzPjwvY29udHJpYnV0b3JzPjxhdXRoLWFkZHJlc3M+Q2FyZGlvdmFzY3VsYXIg
Q2VudGVyLCBUdWZ0cyBNZWRpY2FsIENlbnRlciBhbmQgVHVmdHMgVW5pdmVyc2l0eSBTY2hvb2wg
b2YgTWVkaWNpbmUsIEJvc3RvbiwgTWFzc2FjaHVzZXR0cywgVVNBLjwvYXV0aC1hZGRyZXNzPjx0
aXRsZXM+PHRpdGxlPkxlZnQgdmVudHJpY3VsYXIgcmVtb2RlbGluZyBpbiBoZWFydCBmYWlsdXJl
OiBjdXJyZW50IGNvbmNlcHRzIGluIGNsaW5pY2FsIHNpZ25pZmljYW5jZSBhbmQgYXNzZXNzbWVu
dDwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5KQUNDIENhcmRpb3Zhc2MgSW1hZ2luZzwvc2Vjb25k
YXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRpdGxlPkpBQ0MgQ2FyZGlvdmFz
YyBJbWFnaW5nPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+OTgtMTA4PC9wYWdlcz48
dm9sdW1lPjQ8L3ZvbHVtZT48bnVtYmVyPjE8L251bWJlcj48ZWRpdGlvbj4yMDExLzAxLzE1PC9l
ZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BbmltYWxzPC9rZXl3b3JkPjxrZXl3b3JkPkVjaG9j
YXJkaW9ncmFwaHk8L2tleXdvcmQ+PGtleXdvcmQ+SGVhcnQgRmFpbHVyZS9kaWFnbm9zaXMvKnBo
eXNpb3BhdGhvbG9neS90aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48
a2V5d29yZD5NYWduZXRpYyBSZXNvbmFuY2UgSW1hZ2luZzwva2V5d29yZD48a2V5d29yZD5Qcm9n
bm9zaXM8L2tleXdvcmQ+PGtleXdvcmQ+UmFkaW9udWNsaWRlIFZlbnRyaWN1bG9ncmFwaHk8L2tl
eXdvcmQ+PGtleXdvcmQ+KlZlbnRyaWN1bGFyIFJlbW9kZWxpbmc8L2tleXdvcmQ+PC9rZXl3b3Jk
cz48ZGF0ZXM+PHllYXI+MjAxMTwveWVhcj48cHViLWRhdGVzPjxkYXRlPkphbjwvZGF0ZT48L3B1
Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjE4NzYtNzU5MSAoRWxlY3Ryb25pYyk8L2lzYm4+PGFjY2Vz
c2lvbi1udW0+MjEyMzI3MTI8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJs
Pmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9lbnRyZXovcXVlcnkuZmNnaT9jbWQ9UmV0cmll
dmUmYW1wO2RiPVB1Yk1lZCZhbXA7ZG9wdD1DaXRhdGlvbiZhbXA7bGlzdF91aWRzPTIxMjMyNzEy
PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT5TMTkz
Ni04NzhYKDEwKTAwNzM2LTkgW3BpaV0mI3hEOzEwLjEwMTYvai5qY21nLjIwMTAuMTAuMDA4PC9l
bGVjdHJvbmljLXJlc291cmNlLW51bT48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48
L0NpdGU+PENpdGU+PEF1dGhvcj5DaG88L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxSZWNOdW0+
MTA1ODwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+MTA1ODwvcmVjLW51bWJlcj48Zm9yZWln
bi1rZXlzPjxrZXkgYXBwPSJFTiIgZGItaWQ9Ing1d2R2eHoyZWZ4dHplZXJwZXU1ZGVwMHQ5NXpy
enIycjA5cyIgdGltZXN0YW1wPSIxMzYxMzY3NjQ3Ij4xMDU4PC9rZXk+PC9mb3JlaWduLWtleXM+
PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRv
cnM+PGF1dGhvcnM+PGF1dGhvcj5DaG8sIEguPC9hdXRob3I+PGF1dGhvcj5CYXJ0aCwgQS4gUy48
L2F1dGhvcj48YXV0aG9yPlRvbWFzZWxsaSwgRy4gRi48L2F1dGhvcj48L2F1dGhvcnM+PC9jb250
cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5EZXBhcnRtZW50IG9mIFBoeXNpb2xvZ3ksIFN1bmdreXVu
a3dhbiBVbml2ZXJzaXR5IFNjaG9vbCBvZiBNZWRpY2luZSwgU3V3b24sIEtvcmVhLiBoYW5hY2hv
QHNra3UuZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+QmFzaWMgc2NpZW5jZSBvZiBj
YXJkaWFjIHJlc3luY2hyb25pemF0aW9uIHRoZXJhcHk6IG1vbGVjdWxhciBhbmQgZWxlY3Ryb3Bo
eXNpb2xvZ2ljYWwgbWVjaGFuaXNtczwvdGl0bGU+PHNlY29uZGFyeS10aXRsZT5DaXJjIEFycmh5
dGhtIEVsZWN0cm9waHlzaW9sPC9zZWNvbmRhcnktdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+
PGZ1bGwtdGl0bGU+Q2lyYyBBcnJoeXRobSBFbGVjdHJvcGh5c2lvbDwvZnVsbC10aXRsZT48L3Bl
cmlvZGljYWw+PHBhZ2VzPjU5NC02MDM8L3BhZ2VzPjx2b2x1bWU+NTwvdm9sdW1lPjxudW1iZXI+
MzwvbnVtYmVyPjxlZGl0aW9uPjIwMTIvMDYvMjE8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3b3Jk
PkFuaW1hbHM8L2tleXdvcmQ+PGtleXdvcmQ+KkFycmh5dGhtaWFzLCBDYXJkaWFjL21ldGFib2xp
c20vcGh5c2lvcGF0aG9sb2d5L3RoZXJhcHk8L2tleXdvcmQ+PGtleXdvcmQ+KkJpb21lZGljYWwg
UmVzZWFyY2g8L2tleXdvcmQ+PGtleXdvcmQ+KkNhcmRpYWMgUmVzeW5jaHJvbml6YXRpb24gVGhl
cmFweTwva2V5d29yZD48a2V5d29yZD5FbGVjdHJvcGh5c2lvbG9naWNhbCBQaGVub21lbmEvKnBo
eXNpb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SGVhcnQgQ29uZHVjdGlvbiBTeXN0ZW0vKm1ldGFi
b2xpc20vcGh5c2lvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48
a2V5d29yZD5SZWNlcHRvcnMsIEFkcmVuZXJnaWMvKm1ldGFib2xpc208L2tleXdvcmQ+PC9rZXl3
b3Jkcz48ZGF0ZXM+PHllYXI+MjAxMjwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1biAxPC9kYXRl
PjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTk0MS0zMDg0IChFbGVjdHJvbmljKSYjeEQ7MTk0
MS0zMDg0IChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4yMjcxNTIzODwvYWNjZXNzaW9u
LW51bT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292
L2VudHJlei9xdWVyeS5mY2dpP2NtZD1SZXRyaWV2ZSZhbXA7ZGI9UHViTWVkJmFtcDtkb3B0PUNp
dGF0aW9uJmFtcDtsaXN0X3VpZHM9MjI3MTUyMzg8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+
PGN1c3RvbTI+MzQyMjc1MTwvY3VzdG9tMj48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+NS8zLzU5
NCBbcGlpXSYjeEQ7MTAuMTE2MS9DSVJDRVAuMTExLjk2Mjc0NjwvZWxlY3Ryb25pYy1yZXNvdXJj
ZS1udW0+PGxhbmd1YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjwvRW5kTm90ZT4A
ADDIN EN.CITE.DATA 6, 7 Despite this, in the first two years after MI, mortality of greater than 25% occurs in patients with LVEF of 31-40%, compared to less than 15% when LVEF is greater than 50%.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb2xsZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb2xsZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 5 It is important therefore to consider adjunctive therapies such as cardiac rehabilitation (CR) exercise training which may enhance the reverse LV remodeling seen with medical treatment. Evidence of reverse LV remodeling, following CR exercise training in post-MI patients is equivocal. ADDIN EN.CITE <EndNote><Cite><Author>Haykowsky</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haykowsky, M.</author><author>Scott, J.</author><author>Esch, B.</author><author>Schopflocher, D.</author><author>Myers, J.</author><author>Paterson, I.</author><author>Warburton, D.</author><author>Jones, L.</author><author>Clark, A. M.</author></authors></contributors><auth-address>University of Alberta, Edmonton, Canada. Mark.Haykowsky@ualberta.ca</auth-address><titles><title>A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling</title><secondary-title>Trials</secondary-title></titles><periodical><full-title>Trials</full-title></periodical><pages>92</pages><volume>12</volume><edition>2011/04/06</edition><keywords><keyword>Evidence-Based Medicine</keyword><keyword>Exercise Therapy</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/pathology/physiopathology/*rehabilitation</keyword><keyword>Stroke Volume</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword><keyword>*Ventricular Function, Left</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2011</year><pub-dates><date>2011</date></pub-dates></dates><isbn>1745-6215 (Electronic)
1745-6215 (Linking)</isbn><accession-num>21463531</accession-num><urls><related-urls><url> [pii]
10.1186/1745-6215-12-92</electronic-resource-num><language>eng</language></record></Cite></EndNote>8 Longitudinal studies have shown a positive effect on LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), LVEF and N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP),PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwOTwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwOTwvWWVh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ADDIN EN.CITE.DATA 9-11 but conflicting data exist.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdWJvPC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdWJvPC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 12, 13 Furthermore, a recent meta-analysis showing an overall beneficial effect of CR exercise training on LV remodeling, was limited by the poor methodological quality of some of the studies included. ADDIN EN.CITE <EndNote><Cite><Author>Haykowsky</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haykowsky, M.</author><author>Scott, J.</author><author>Esch, B.</author><author>Schopflocher, D.</author><author>Myers, J.</author><author>Paterson, I.</author><author>Warburton, D.</author><author>Jones, L.</author><author>Clark, A. M.</author></authors></contributors><auth-address>University of Alberta, Edmonton, Canada. Mark.Haykowsky@ualberta.ca</auth-address><titles><title>A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling</title><secondary-title>Trials</secondary-title></titles><periodical><full-title>Trials</full-title></periodical><pages>92</pages><volume>12</volume><edition>2011/04/06</edition><keywords><keyword>Evidence-Based Medicine</keyword><keyword>Exercise Therapy</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/pathology/physiopathology/*rehabilitation</keyword><keyword>Stroke Volume</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword><keyword>*Ventricular Function, Left</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2011</year><pub-dates><date>2011</date></pub-dates></dates><isbn>1745-6215 (Electronic)
1745-6215 (Linking)</isbn><accession-num>21463531</accession-num><urls><related-urls><url> [pii]
10.1186/1745-6215-12-92</electronic-resource-num><language>eng</language></record></Cite></EndNote>8 To date, CR exercise training studies have focused almost exclusively on patients with moderate to severe impairment of LV systolic function (LVEF ≤45%). These patients are often limited by their condition and are, therefore, obvious candidates for CR exercise training. However, advances in percutaneous coronary artery revascularization, rapid 24 hr access to treatment, greater sensitivity of cardiac biomarkers, and increased awareness of chest pain management have led to a growing population of asymptomatic MI survivors with preserved LV systolic function (LVEF>45%).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaW08L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxSZWNO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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaW08L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxSZWNO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ADDIN EN.CITE.DATA 14, 15 In the absence of significant functional limitation, these patients can be quickly reintegrated into daily life, making their attendance on CR exercise programmes less likely. This may be ill advised given that 15% of these patients will die or be hospitalised with heart failure within 20 months of MI.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbW9uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbW9uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48
UmVjTnVtPjMzNjwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUgZmFjZT0ic3VwZXJzY3JpcHQi
PjE2PC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1udW1iZXI+MzM2PC9yZWMtbnVt
YmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieDV3ZHZ4ejJlZnh0emVlcnBl
dTVkZXAwdDk1enJ6cjJyMDlzIiB0aW1lc3RhbXA9IjEzNTA5ODk5MTgiPjMzNjwva2V5PjwvZm9y
ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48
Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+U29sb21vbiwgUy4gRC48L2F1dGhvcj48YXV0
aG9yPlNrYWxpLCBILjwvYXV0aG9yPjxhdXRob3I+QW5hdmVrYXIsIE4uIFMuPC9hdXRob3I+PGF1
dGhvcj5Cb3VyZ291biwgTS48L2F1dGhvcj48YXV0aG9yPkJhcnZpaywgUy48L2F1dGhvcj48YXV0
aG9yPkdoYWxpLCBKLiBLLjwvYXV0aG9yPjxhdXRob3I+V2FybmljYSwgSi4gVy48L2F1dGhvcj48
YXV0aG9yPktocmFrb3Zza2F5YSwgTS48L2F1dGhvcj48YXV0aG9yPkFybm9sZCwgSi4gTS48L2F1
dGhvcj48YXV0aG9yPlNjaHdhcnR6LCBZLjwvYXV0aG9yPjxhdXRob3I+VmVsYXpxdWV6LCBFLiBK
LjwvYXV0aG9yPjxhdXRob3I+Q2FsaWZmLCBSLiBNLjwvYXV0aG9yPjxhdXRob3I+TWNNdXJyYXks
IEouIFYuPC9hdXRob3I+PGF1dGhvcj5QZmVmZmVyLCBNLiBBLjwvYXV0aG9yPjwvYXV0aG9ycz48
L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkNhcmRpb3Zhc2N1bGFyIERpdmlzaW9uLCBCcmln
aGFtIGFuZCBXb21lbiZhcG9zO3MgSG9zcGl0YWwsIEhhcnZhcmQgTWVkaWNhbCBTY2hvb2wsIEJv
c3RvbiwgTWFzcyAwMjExNSwgVVNBLiBzc29sb21vbkByaWNzLmJ3aC5oYXJ2YXJkLmVkdTwvYXV0
aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkNoYW5nZXMgaW4gdmVudHJpY3VsYXIgc2l6ZSBhbmQg
ZnVuY3Rpb24gaW4gcGF0aWVudHMgdHJlYXRlZCB3aXRoIHZhbHNhcnRhbiwgY2FwdG9wcmlsLCBv
ciBib3RoIGFmdGVyIG15b2NhcmRpYWwgaW5mYXJjdGlvbjwvdGl0bGU+PHNlY29uZGFyeS10aXRs
ZT5DaXJjdWxhdGlvbjwvc2Vjb25kYXJ5LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxs
LXRpdGxlPkNpcmN1bGF0aW9uPC9mdWxsLXRpdGxlPjwvcGVyaW9kaWNhbD48cGFnZXM+MzQxMS05
PC9wYWdlcz48dm9sdW1lPjExMTwvdm9sdW1lPjxudW1iZXI+MjU8L251bWJlcj48ZWRpdGlvbj4y
MDA1LzA2LzIyPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BZ2VkPC9rZXl3b3JkPjxrZXl3
b3JkPkFuZ2lvdGVuc2luLUNvbnZlcnRpbmcgRW56eW1lIEluaGliaXRvcnMvcGhhcm1hY29sb2d5
L3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29yZD5DYXB0b3ByaWwvYWRtaW5pc3RyYXRp
b24gJmFtcDsgZG9zYWdlLypwaGFybWFjb2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+RHJ1ZyBUaGVy
YXB5LCBDb21iaW5hdGlvbjwva2V5d29yZD48a2V5d29yZD5FbGVjdHJvY2FyZGlvZ3JhcGh5PC9r
ZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IZWFydCBWZW50cmljbGVz
LypkcnVnIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+SG9zcGl0YWxpemF0aW9uPC9rZXl3b3Jk
PjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5IeXBlcnRyb3BoeSwgTGVmdCBWZW50
cmljdWxhci8qZHJ1ZyB0aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tleXdvcmQ+PGtl
eXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+TXlvY2FyZGlhbCBJbmZhcmN0aW9u
LypkcnVnIHRoZXJhcHkvbW9ydGFsaXR5PC9rZXl3b3JkPjxrZXl3b3JkPlByb2dub3Npczwva2V5
d29yZD48a2V5d29yZD5TdHJva2UgVm9sdW1lL2RydWcgZWZmZWN0czwva2V5d29yZD48a2V5d29y
ZD5UZXRyYXpvbGVzL2FkbWluaXN0cmF0aW9uICZhbXA7IGRvc2FnZS8qcGhhcm1hY29sb2d5PC9r
ZXl3b3JkPjxrZXl3b3JkPlRyZWF0bWVudCBPdXRjb21lPC9rZXl3b3JkPjxrZXl3b3JkPlZhbGlu
ZS9hZG1pbmlzdHJhdGlvbiAmYW1wOyBkb3NhZ2UvKmFuYWxvZ3MgJmFtcDsgZGVyaXZhdGl2ZXMv
cGhhcm1hY29sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPlZlbnRyaWN1bGFyIER5c2Z1bmN0aW9uLCBM
ZWZ0LypkcnVnIHRoZXJhcHk8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+MjAwNTwv
eWVhcj48cHViLWRhdGVzPjxkYXRlPkp1biAyODwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxp
c2JuPjE1MjQtNDUzOSAoRWxlY3Ryb25pYykmI3hEOzAwMDktNzMyMiAoTGlua2luZyk8L2lzYm4+
PGFjY2Vzc2lvbi1udW0+MTU5Njc4NDY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJs
cz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9lbnRyZXovcXVlcnkuZmNnaT9jbWQ9
UmV0cmlldmUmYW1wO2RiPVB1Yk1lZCZhbXA7ZG9wdD1DaXRhdGlvbiZhbXA7bGlzdF91aWRzPTE1
OTY3ODQ2PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51
bT5DSVJDVUxBVElPTkFIQS4xMDQuNTA4MDkzIFtwaWldJiN4RDsxMC4xMTYxL0NJUkNVTEFUSU9O
QUhBLjEwNC41MDgwOTM8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxsYW5ndWFnZT5lbmc8L2xh
bmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE.DATA 16 Exercise training may be an effective preventative strategy, ameliorating the negative effects of chronic LV remodeling, yet the impact of CR exercise training on LV structure and function has not been studied in this group of patients. Therefore, the purpose of the current study was to investigate the effect of CR exercise training on LV structure and function in post-MI patients with preserved LVEF (>45%). It was hypothesized that 10 weeks of CR exercise training would reduce LV volumes and increase LVEF in addition to improving functional capacity.Materials and methodsStudy population and protocolA total of 56 consecutive male participants were recruited to the study. An exercise training group was populated by those who attended CR (N.=36) and a non-exercise group by those who were demographically and clinically similar to the exercise group but were unable to attend structured CR due to work or personal commitments (N.=20) (Table I). Participants were clinically stable (in accordance with guidelines) ADDIN EN.CITE <EndNote><Cite><Author>ACSM</Author><Year>2010</Year><RecNum>1115</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>1115</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1362154869">1115</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>ACSM</author></authors></contributors><titles><title>Guidelines for exercise testing and prescription</title></titles><pages>209</pages><edition>8th</edition><section>209</section><dates><year>2010</year></dates><publisher><style face="normal" font="default" size="100%">Lippincott Williams & Wilkins</style><style face="normal" font="Times New Roman" size="100%">
</style></publisher><urls></urls></record></Cite></EndNote>17 following treatment for an acute MI at least three, but not more than six weeks previously. All participants had LVEF >45% and were asymptomatic following successful percutaneous coronary intervention. The absence of exercise induced angina and/or ischemic ECG changes was confirmed with cardiopulmonary exercise testing. Participants who did not meet guidelines for inclusion in exercise training ADDIN EN.CITE <EndNote><Cite><Author>ACSM</Author><Year>2010</Year><RecNum>1115</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>1115</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1362154869">1115</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>ACSM</author></authors></contributors><titles><title>Guidelines for exercise testing and prescription</title></titles><pages>209</pages><edition>8th</edition><section>209</section><dates><year>2010</year></dates><publisher><style face="normal" font="default" size="100%">Lippincott Williams & Wilkins</style><style face="normal" font="Times New Roman" size="100%">
</style></publisher><urls></urls></record></Cite></EndNote>17 or who had significant limiting comorbidities were excluded. Both groups were advised on a cardio-protective lifestyle including general physical activity. Approval was gained from the local Research and Ethics Committee (08/H1210/56), informed consent was obtained from all participants and the study complied with all aspects of the Declaration of Helsinki. Prior to and on completion of a 10-week supervised exercise training programme or non-exercise control period, transthoracic echocardiography and cardiopulmonary exercise testing were undertaken in all study participants. In addition, resting whole blood samples for the assessment of NT-pro-BNP were obtained in a sub-group (N.=21) of exercise training participants willing to undergo additional phlebotomy. Other than sedentary behavior, which was determined through self-reported non-adherence to current physical activity guidelines, the presence of cardiovascular disease risk factors was identified from participants’ medical notes. Cardiopulmonary exercise testingCardiopulmonary exercise testing was performed in accordance with the American Thoracic Society guidelines. ADDIN EN.CITE <EndNote><Cite><Author>Ross</Author><Year>2003</Year><RecNum>47</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>47</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">47</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ross, R. M.</author></authors></contributors><titles><title>ATS/ACCP statement on cardiopulmonary exercise testing</title><secondary-title>Am J Respir Crit Care Med</secondary-title></titles><periodical><full-title>Am J Respir Crit Care Med</full-title></periodical><pages>1451; author reply 1451</pages><volume>167</volume><number>10</number><edition>2003/05/10</edition><keywords><keyword>Cardiovascular Diseases/*diagnosis</keyword><keyword>Exercise Test</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Lung Diseases/*diagnosis</keyword><keyword>Male</keyword><keyword>*Practice Guidelines as Topic</keyword><keyword>Respiratory Function Tests</keyword><keyword>Sensitivity and Specificity</keyword><keyword>Severity of Illness Index</keyword><keyword>Societies, Medical</keyword><keyword>United States</keyword></keywords><dates><year>2003</year><pub-dates><date>May 15</date></pub-dates></dates><isbn>1073-449X (Print)
1073-449X (Linking)</isbn><accession-num>12738602</accession-num><urls><related-urls><url> [pii]</electronic-resource-num><language>eng</language></record></Cite></EndNote>18 Briefly, a standard ramp protocol was conducted on an electronically braked, upright cycle ergometer with continuous respiratory gas exchange measurements of oxygen uptake (VO2), carbon dioxide production (VCO2) and minute ventilation (VE) (Oxycon Pro, Care Fusion Corp., San Diego, CA, USA). Electrocardiogram, blood pressure and rating of perceived exertion (RPE) were monitored throughout and participants were encouraged to continue until symptom limited volitional fatigue, with a respiratory exchange ratio of >1.15 indicating maximal effort.EchocardiographyResting echocardiographic images were acquired in accordance with British Society of Echocardiography guidelines ADDIN EN.CITE <EndNote><Cite><Author>British Society of Echocardiography</Author><Year>2012</Year><RecNum>1558</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>1558</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s">1558</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>British Society of Echocardiography,</author></authors></contributors><titles><title>A minimum dataset for a standard transthoracic echocardiogram</title></titles><dates><year>2012</year></dates><pub-location>London, UK</pub-location><urls></urls></record></Cite></EndNote>19 by a single cardiac sonographer, blinded to group allocation. A commercially available ultrasound system (Vivid 7, GE Medical Systems, Horten, Norway) was used to obtain and store images for subsequent off-line analysis (Echo-pac, GE Medical Systems, Horten, Norway, version 7.0.0). Left ventricular internal dimensions and wall thicknesses, and atrial diameter, were measured from the parasternal long axis view, and LV volumes calculated using the Simpson’s bi-plane method from apical two and apical four-chamber images. LV mass and relative wall thickness were calculated according to Lang et al., (2015).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYW5nPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYW5nPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
TnVtPjEyNzA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4y
MDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjEyNzA8L3JlYy1udW1i
ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4NXdkdnh6MmVmeHR6ZWVycGV1
NWRlcDB0OTV6cnpyMnIwOXMiIHRpbWVzdGFtcD0iMTQyNDM2OTg3NSI+MTI3MDwva2V5PjwvZm9y
ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48
Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+TGFuZywgUi4gTS48L2F1dGhvcj48YXV0aG9y
PkJhZGFubywgTC4gUC48L2F1dGhvcj48YXV0aG9yPk1vci1BdmksIFYuPC9hdXRob3I+PGF1dGhv
cj5BZmlsYWxvLCBKLjwvYXV0aG9yPjxhdXRob3I+QXJtc3Ryb25nLCBBLjwvYXV0aG9yPjxhdXRo
b3I+RXJuYW5kZSwgTC48L2F1dGhvcj48YXV0aG9yPkZsYWNoc2thbXBmLCBGLiBBLjwvYXV0aG9y
PjxhdXRob3I+Rm9zdGVyLCBFLjwvYXV0aG9yPjxhdXRob3I+R29sZHN0ZWluLCBTLiBBLjwvYXV0
aG9yPjxhdXRob3I+S3V6bmV0c292YSwgVC48L2F1dGhvcj48YXV0aG9yPkxhbmNlbGxvdHRpLCBQ
LjwvYXV0aG9yPjxhdXRob3I+TXVyYXJ1LCBELjwvYXV0aG9yPjxhdXRob3I+UGljYXJkLCBNLiBI
LjwvYXV0aG9yPjxhdXRob3I+UmlldHpzY2hlbCwgRS4gUi48L2F1dGhvcj48YXV0aG9yPlJ1ZHNr
aSwgTC48L2F1dGhvcj48YXV0aG9yPlNwZW5jZXIsIEsuIFQuPC9hdXRob3I+PGF1dGhvcj5Uc2Fu
ZywgVy48L2F1dGhvcj48YXV0aG9yPlZvaWd0LCBKLiBVLjwvYXV0aG9yPjwvYXV0aG9ycz48L2Nv
bnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlVuaXZlcnNpdHkgb2YgQ2hpY2FnbyBNZWRpY2FsIENl
bnRlciwgQ2hpY2FnbywgSWxsaW5vaXMuJiN4RDtVbml2ZXJzaXR5IG9mIFBhZHVhLCBQYWR1YSwg
SXRhbHkuJiN4RDtKZXdpc2ggR2VuZXJhbCBIb3NwaXRhbCwgTWNHaWxsIFVuaXZlcnNpdHksIE1v
bnRyZWFsLCBRdWViZWMsIENhbmFkYS4mI3hEO0pvaG5zIEhvcGtpbnMgVW5pdmVyc2l0eSwgQmFs
dGltb3JlLCBNYXJ5bGFuZC4mI3hEO0lOU0VSTSBVOTU1IGFuZCBIb3BpdGFsIEhlbnJpIE1vbmRv
ciwgQ3JldGVpbCwgRnJhbmNlLiYjeEQ7VXBwc2FsYSBVbml2ZXJzaXR5LCBVcHBzYWxhLCBTd2Vk
ZW4uJiN4RDtVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEsIFNhbiBGcmFuY2lzY28sIENhbGlmb3Ju
aWEuJiN4RDtNZWRzdGFyIFdhc2hpbmd0b24gSG9zcGl0YWwgQ2VudGVyLCBXYXNoaW5ndG9uLCBE
aXN0cmljdCBvZiBDb2x1bWJpYS4mI3hEO1VuaXZlcnNpdHkgSG9zcGl0YWwgTGV1dmVuLCBMZXV2
ZW4sIEJlbGdpdW0uJiN4RDtVbml2ZXJzaXR5IG9mIExpZWdlIEhvc3BpdGFsLCBMaWVnZSwgQmVs
Z2l1bS4mI3hEO01hc3NhY2h1c2V0dHMgR2VuZXJhbCBIb3NwaXRhbCBhbmQgSGFydmFyZCBNZWRp
Y2FsIFNjaG9vbCwgQm9zdG9uLCBNYXNzYWNodXNldHRzLiYjeEQ7R2hlbnQgVW5pdmVyc2l0eSBI
b3NwaXRhbCwgR2hlbnQsIEJlbGdpdW0uJiN4RDtVbml2ZXJzaXR5IG9mIFRvcm9udG8sIFRvcm9u
dG8sIE9udGFyaW8sIENhbmFkYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5SZWNvbW1l
bmRhdGlvbnMgZm9yIGNhcmRpYWMgY2hhbWJlciBxdWFudGlmaWNhdGlvbiBieSBlY2hvY2FyZGlv
Z3JhcGh5IGluIGFkdWx0czogYW4gdXBkYXRlIGZyb20gdGhlIGFtZXJpY2FuIHNvY2lldHkgb2Yg
ZWNob2NhcmRpb2dyYXBoeSBhbmQgdGhlIEV1cm9wZWFuIGFzc29jaWF0aW9uIG9mIGNhcmRpb3Zh
c2N1bGFyIGltYWdpbmc8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+SiBBbSBTb2MgRWNob2NhcmRp
b2dyPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Kb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBT
b2NpZXR5IG9mIEVjaG9jYXJkaW9ncmFwaHkgOiBvZmZpY2lhbCBwdWJsaWNhdGlvbiBvZiB0aGUg
QW1lcmljYW4gU29jaWV0eSBvZiBFY2hvY2FyZGlvZ3JhcGh5PC9hbHQtdGl0bGU+PC90aXRsZXM+
PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBBbSBTb2MgRWNob2NhcmRpb2dyPC9mdWxsLXRpdGxl
PjwvcGVyaW9kaWNhbD48cGFnZXM+MS0zOSBlMTQ8L3BhZ2VzPjx2b2x1bWU+Mjg8L3ZvbHVtZT48
bnVtYmVyPjE8L251bWJlcj48ZGF0ZXM+PHllYXI+MjAxNTwveWVhcj48cHViLWRhdGVzPjxkYXRl
PkphbjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEwOTctNjc5NSAoRWxlY3Ryb25p
YykmI3hEOzA4OTQtNzMxNyAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjU1NTk0NzM8
L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmNiaS5u
bG0ubmloLmdvdi9wdWJtZWQvMjU1NTk0NzM8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVs
ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5lY2hvLjIwMTQuMTAuMDAzPC9lbGVjdHJv
bmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE.DATA 20 Peak early (E) and late (A) mitral inflow velocity, and the E-wave deceleration time (DT) were measured with pulse wave Doppler in the apical four-chamber view, and the E/A ratio calculated. Finally, tissue Doppler imaging of the septal and lateral mitral annuli in the apical four-chamber view was employed to quantify systolic (s’), early diastolic (e’) and late diastolic (a’) peak mitral annulus tissue velocities. Intraobserver variability has been previously assessed in our laboratory for standard 2D, Doppler and Tissue Doppler Indices of LV function. In healthy participants and those with LV dysfunction, the coefficient of variation was within an acceptable range for diagnosis and interpretation, and in keeping with data published by the American Society of Echocardiography.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYW5nPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj
TnVtPjEyNzA8L1JlY051bT48RGlzcGxheVRleHQ+PHN0eWxlIGZhY2U9InN1cGVyc2NyaXB0Ij4y
MDwvc3R5bGU+PC9EaXNwbGF5VGV4dD48cmVjb3JkPjxyZWMtbnVtYmVyPjEyNzA8L3JlYy1udW1i
ZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4NXdkdnh6MmVmeHR6ZWVycGV1
NWRlcDB0OTV6cnpyMnIwOXMiIHRpbWVzdGFtcD0iMTQyNDM2OTg3NSI+MTI3MDwva2V5PjwvZm9y
ZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYtdHlwZT48
Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+TGFuZywgUi4gTS48L2F1dGhvcj48YXV0aG9y
PkJhZGFubywgTC4gUC48L2F1dGhvcj48YXV0aG9yPk1vci1BdmksIFYuPC9hdXRob3I+PGF1dGhv
cj5BZmlsYWxvLCBKLjwvYXV0aG9yPjxhdXRob3I+QXJtc3Ryb25nLCBBLjwvYXV0aG9yPjxhdXRo
b3I+RXJuYW5kZSwgTC48L2F1dGhvcj48YXV0aG9yPkZsYWNoc2thbXBmLCBGLiBBLjwvYXV0aG9y
PjxhdXRob3I+Rm9zdGVyLCBFLjwvYXV0aG9yPjxhdXRob3I+R29sZHN0ZWluLCBTLiBBLjwvYXV0
aG9yPjxhdXRob3I+S3V6bmV0c292YSwgVC48L2F1dGhvcj48YXV0aG9yPkxhbmNlbGxvdHRpLCBQ
LjwvYXV0aG9yPjxhdXRob3I+TXVyYXJ1LCBELjwvYXV0aG9yPjxhdXRob3I+UGljYXJkLCBNLiBI
LjwvYXV0aG9yPjxhdXRob3I+UmlldHpzY2hlbCwgRS4gUi48L2F1dGhvcj48YXV0aG9yPlJ1ZHNr
aSwgTC48L2F1dGhvcj48YXV0aG9yPlNwZW5jZXIsIEsuIFQuPC9hdXRob3I+PGF1dGhvcj5Uc2Fu
ZywgVy48L2F1dGhvcj48YXV0aG9yPlZvaWd0LCBKLiBVLjwvYXV0aG9yPjwvYXV0aG9ycz48L2Nv
bnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlVuaXZlcnNpdHkgb2YgQ2hpY2FnbyBNZWRpY2FsIENl
bnRlciwgQ2hpY2FnbywgSWxsaW5vaXMuJiN4RDtVbml2ZXJzaXR5IG9mIFBhZHVhLCBQYWR1YSwg
SXRhbHkuJiN4RDtKZXdpc2ggR2VuZXJhbCBIb3NwaXRhbCwgTWNHaWxsIFVuaXZlcnNpdHksIE1v
bnRyZWFsLCBRdWViZWMsIENhbmFkYS4mI3hEO0pvaG5zIEhvcGtpbnMgVW5pdmVyc2l0eSwgQmFs
dGltb3JlLCBNYXJ5bGFuZC4mI3hEO0lOU0VSTSBVOTU1IGFuZCBIb3BpdGFsIEhlbnJpIE1vbmRv
ciwgQ3JldGVpbCwgRnJhbmNlLiYjeEQ7VXBwc2FsYSBVbml2ZXJzaXR5LCBVcHBzYWxhLCBTd2Vk
ZW4uJiN4RDtVbml2ZXJzaXR5IG9mIENhbGlmb3JuaWEsIFNhbiBGcmFuY2lzY28sIENhbGlmb3Ju
aWEuJiN4RDtNZWRzdGFyIFdhc2hpbmd0b24gSG9zcGl0YWwgQ2VudGVyLCBXYXNoaW5ndG9uLCBE
aXN0cmljdCBvZiBDb2x1bWJpYS4mI3hEO1VuaXZlcnNpdHkgSG9zcGl0YWwgTGV1dmVuLCBMZXV2
ZW4sIEJlbGdpdW0uJiN4RDtVbml2ZXJzaXR5IG9mIExpZWdlIEhvc3BpdGFsLCBMaWVnZSwgQmVs
Z2l1bS4mI3hEO01hc3NhY2h1c2V0dHMgR2VuZXJhbCBIb3NwaXRhbCBhbmQgSGFydmFyZCBNZWRp
Y2FsIFNjaG9vbCwgQm9zdG9uLCBNYXNzYWNodXNldHRzLiYjeEQ7R2hlbnQgVW5pdmVyc2l0eSBI
b3NwaXRhbCwgR2hlbnQsIEJlbGdpdW0uJiN4RDtVbml2ZXJzaXR5IG9mIFRvcm9udG8sIFRvcm9u
dG8sIE9udGFyaW8sIENhbmFkYS48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5SZWNvbW1l
bmRhdGlvbnMgZm9yIGNhcmRpYWMgY2hhbWJlciBxdWFudGlmaWNhdGlvbiBieSBlY2hvY2FyZGlv
Z3JhcGh5IGluIGFkdWx0czogYW4gdXBkYXRlIGZyb20gdGhlIGFtZXJpY2FuIHNvY2lldHkgb2Yg
ZWNob2NhcmRpb2dyYXBoeSBhbmQgdGhlIEV1cm9wZWFuIGFzc29jaWF0aW9uIG9mIGNhcmRpb3Zh
c2N1bGFyIGltYWdpbmc8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+SiBBbSBTb2MgRWNob2NhcmRp
b2dyPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5Kb3VybmFsIG9mIHRoZSBBbWVyaWNhbiBT
b2NpZXR5IG9mIEVjaG9jYXJkaW9ncmFwaHkgOiBvZmZpY2lhbCBwdWJsaWNhdGlvbiBvZiB0aGUg
QW1lcmljYW4gU29jaWV0eSBvZiBFY2hvY2FyZGlvZ3JhcGh5PC9hbHQtdGl0bGU+PC90aXRsZXM+
PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBBbSBTb2MgRWNob2NhcmRpb2dyPC9mdWxsLXRpdGxl
PjwvcGVyaW9kaWNhbD48cGFnZXM+MS0zOSBlMTQ8L3BhZ2VzPjx2b2x1bWU+Mjg8L3ZvbHVtZT48
bnVtYmVyPjE8L251bWJlcj48ZGF0ZXM+PHllYXI+MjAxNTwveWVhcj48cHViLWRhdGVzPjxkYXRl
PkphbjwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjEwOTctNjc5NSAoRWxlY3Ryb25p
YykmI3hEOzA4OTQtNzMxNyAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MjU1NTk0NzM8
L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmNiaS5u
bG0ubmloLmdvdi9wdWJtZWQvMjU1NTk0NzM8L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVs
ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEwMTYvai5lY2hvLjIwMTQuMTAuMDAzPC9lbGVjdHJv
bmljLXJlc291cmNlLW51bT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MYW5nPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 20Measurement of cardiac biomarkersSerum was obtained from whole blood samples collected into ethylene diamine teracetic acid tubes via peripheral venepuncture. Clotted samples were centrifuged at 3000 rpm for 10 min and stored at -80 deg C. NT-pro-BNP was determined using the Immulite 2500 electrochemiluminescent immunoassay (Siemens Healthcare Diagnostics, Frimley, UK) with a linear calibration range of 20 to 35,000 pg/mL and a cut-off value for exclusion of LVSD of 75 pg/mL in patients aged 50-75 yrs.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaWxkZWJyYW5kdDwvQXV0aG9yPjxZZWFyPjIwMTA8L1ll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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaWxkZWJyYW5kdDwvQXV0aG9yPjxZZWFyPjIwMTA8L1ll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ADDIN EN.CITE.DATA 21Exercise trainingParticipants attended University Hospital, Coventry twice weekly for 10 weeks with an adherence rate of 85% (17 of 20 sessions) designated as the required standard for inclusion. Cardiovascular exercise was split equally between treadmill, cycle ergometer, rowing machine and cross-trainer. A 10 min treadmill or cycle warm up was followed initially by 25 min of continuous cardiovascular exercise. A 5 min cool down walk was performed prior to and on completion of a standardized resistance training programme consisting of 1 set per exercise. Resistance training machines were used to perform 5 upper and 2 lower body exercises such that no more than 12 repetitions could be completed, without straining. ADDIN EN.CITE <EndNote><Cite><Author>ACSM</Author><Year>2010</Year><RecNum>1115</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>1115</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1362154869">1115</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>ACSM</author></authors></contributors><titles><title>Guidelines for exercise testing and prescription</title></titles><pages>209</pages><edition>8th</edition><section>209</section><dates><year>2010</year></dates><publisher><style face="normal" font="default" size="100%">Lippincott Williams & Wilkins</style><style face="normal" font="Times New Roman" size="100%">
</style></publisher><urls></urls></record></Cite></EndNote>17 Aerobic exercise intensity was initially set at a heart rate corresponding to 60-80% peak oxygen uptake (VO2 peak) from cardiopulmonary exercise test and after two sessions the supervisory team ensured that participants were exercising at a heart rate equivalent to 80% VO2 peak. Exercise intensity and training heart rate range were re-prescribed every two weeks based on RPE. The duration of exercise was progressively increased from 25 to 40 min by the fifth week and was maintained thereafter. Whilst further non-structured, home-based exercise was advised in line with guidelines for secondary prevention, ADDIN EN.CITE <EndNote><Cite><Author>Buckley</Author><Year>2013</Year><RecNum>1268</RecNum><DisplayText><style face="superscript">22</style></DisplayText><record><rec-number>1268</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1424362667">1268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buckley, J. P.</author><author>Furze, G.</author><author>Doherty, P.</author><author>Speck, L.</author><author>Connolly, S.</author><author>Hinton, S.</author><author>Jones, J. L.</author><author>Bacpr,</author></authors></contributors><titles><title>BACPR scientific statement: British standards and core components for cardiovascular disease prevention and rehabilitation</title><secondary-title>Heart</secondary-title><alt-title>Heart</alt-title></titles><periodical><full-title>Heart</full-title></periodical><alt-periodical><full-title>Heart</full-title></alt-periodical><pages>1069-71</pages><volume>99</volume><number>15</number><keywords><keyword>*Cardiovascular Diseases/prevention & control/rehabilitation</keyword><keyword>Evidence-Based Practice/standards</keyword><keyword>Great Britain</keyword><keyword>Humans</keyword><keyword>Patient Care Management/methods/standards</keyword><keyword>Patient Care Team</keyword><keyword>*Standard of Care</keyword></keywords><dates><year>2013</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1468-201X (Electronic)
1355-6037 (Linking)</isbn><accession-num>23403407</accession-num><urls><related-urls><url> this aspect of the programme was not monitored or quantified.Statistical analysisBaseline characteristics and continuous variables are presented as mean±standard deviation (SD). Differences between the exercise training and non-exercise group at baseline were determined using unpaired Student’s t-tests. Further to confirmation of normality with the Kolmogorov-Smirnov Test, the change in outcome variables by group over time was assessed with either a two-way mixed model analysis of variance (ANOVA) or paired Student’s t-tests. Pearson’s product-moment correlation coefficient was used to determine relationships between the relative change (?) in NT-pro-BNP and the absolute change (?) in LV volumetric parameters over the 10 week period in the sub-group of exercise training participants.ResultsRecruitmentOf the 36 participants in the exercise training group, 33 completed ≥17 of 20 sessions during the training period with an average attendance of 88.3%. Two participants were lost to follow-up and one failed to meet the minimum adherence target. In the non-exercise group, a further three participants were lost to follow up. Accordingly, data from 50 participants (exercise training, N.=33 and non-exercise, N.=17) was analyzed to assess the effects of CR exercise training on LV structure and function. Baseline demographic and clinical characteristics were similar between groups (Table I), medication remained unchanged during the study period, and no cardiovascular complications or other adverse effects were experienced by the participants. Cardiopulmonary exercise testingIn comparison to the non-exercise group, maximum workload (Wmax), VO2 peak, ventilatory threshold (VT) and exercise time increased in response to exercise training (all P<0.05) (Table I). In the exercise training group, VO2 peak increased by 16%, Wmax by 19%, VT by 18%, and exercise time by 16% (all P<0.0001) (Table I). In the non-exercise group, no changes were noted. Furthermore, there were no statistical differences in body mass index (BMI), resting heart rate (HRrest), systolic blood pressure (BPsys) or diastolic blood pressure (BPdia) in either group between baseline and poststudy measures (Table I).Effect of cardiac rehabilitation exercise training on left ventricular structure and functionOn completion of the exercise training programme, LVEDV and LVEDV/BSA (both P<0.05), and LVESV and LVESV/BSA (both P<0.01) were decreased in comparison to the non-exercise group. As depicted in Figure 1, 10 weeks of exercise training resulted in a 5% reduction in LVEDV and LVEDV/BSA (both P<0.001) and a 9% reduction in LVESV and LVESV/BSA (both P<0.001), whereas volumetric parameters remained unchanged in the non-exercise group (P>0.05). No changes in either group were observed in LV mass or RWT calculated from linear dimensions (P>0.05) (Table II). The exercise training programme did not have a statistically significant impact on LVEF or Doppler indices of diastolic function, all of which were within normal ranges at baseline (Figure 1, Table III). Relationship between NT-pro-BNP and left ventricular volumetric parametersIn the sub group of exercise training participants (N.=21), resting NT-pro-BNP was significantly lower at the end of the 10 week programme (267±232 vs. 158±121 pg/mL, P<0.01). Additionally, the relative reduction in resting NT-pro-BNP (%) from baseline to 10 weeks correlated positively with the absolute change in LVEDV (mL) (r=0.58, P<0.01, r2=0.33) (Figure 2). There was no significant relationship between the relative change in NT-pro-BNP and the absolute change in either LVESV (r=0.10, P>0.05, r2=0.01) or LVEF (r=0.17, P>0.05, r2=0.03) (Figure 2). DiscussionThe aim of the present study was to evaluate the reverse remodeling effect of CR exercise training in post-MI patients with preserved LVEF (>45%). We hypothesized that, in addition to an improvement in functional capacity, LV volumes would be reduced and LVEF increased. The primary findings were an improvement in exercise capacity and a reduction in LV volumes in response to CR exercise training. Given the association between reduced LV volumes and improved clinical outcome, ADDIN EN.CITE <EndNote><Cite><Author>Konstam</Author><Year>2011</Year><RecNum>311</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>311</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1350989779">311</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Konstam, M. A.</author><author>Kramer, D. G.</author><author>Patel, A. R.</author><author>Maron, M. S.</author><author>Udelson, J. E.</author></authors></contributors><auth-address>Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA.</auth-address><titles><title>Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment</title><secondary-title>JACC Cardiovasc Imaging</secondary-title></titles><periodical><full-title>JACC Cardiovasc Imaging</full-title></periodical><pages>98-108</pages><volume>4</volume><number>1</number><edition>2011/01/15</edition><keywords><keyword>Animals</keyword><keyword>Echocardiography</keyword><keyword>Heart Failure/diagnosis/*physiopathology/therapy</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging</keyword><keyword>Prognosis</keyword><keyword>Radionuclide Ventriculography</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2011</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1876-7591 (Electronic)</isbn><accession-num>21232712</accession-num><urls><related-urls><url>(10)00736-9 [pii]
10.1016/j.jcmg.2010.10.008</electronic-resource-num><language>eng</language></record></Cite></EndNote>6 albeit in patients with more severe LV systolic dysfunction, these data provide additional evidence for the use of CR exercise training in post-MI patients with preserved LVEF. Reverse volumetric remodeling with CR exercise trainingIn patients with significant LV systolic dysfunction, reductions in LV volumes are associated with improved survival.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbW9uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbW9uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE.DATA 16 While data confirming this relation are primarily derived from pharmacological trials, CR exercise training has also been consistently shown to reduce cardiovascular and all-cause mortality in patients with MI. ADDIN EN.CITE <EndNote><Cite><Author>Lawler</Author><Year>2011</Year><RecNum>626</RecNum><DisplayText><style face="superscript">23</style></DisplayText><record><rec-number>626</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1353676325">626</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lawler, P. R.</author><author>Filion, K. B.</author><author>Eisenberg, M. J.</author></authors></contributors><auth-address>Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.</auth-address><titles><title>Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials</title><secondary-title>Am Heart J</secondary-title></titles><periodical><full-title>Am Heart J</full-title></periodical><pages>571-584 e2</pages><volume>162</volume><number>4</number><edition>2011/10/11</edition><keywords><keyword>*Exercise Therapy</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/*rehabilitation</keyword><keyword>*Randomized Controlled Trials as Topic/statistics & numerical data</keyword></keywords><dates><year>2011</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1097-6744 (Electronic)
0002-8703 (Linking)</isbn><accession-num>21982647</accession-num><urls><related-urls><url>(11)00559-X [pii]
10.1016/j.ahj.2011.07.017</electronic-resource-num><language>eng</language></record></Cite></EndNote>23 The mechanisms responsible for this remain to be fully elucidated, but are likely to include both structural and functional cardiac remodeling. The reduction in LV volumes observed in the current study confirm findings from a recent meta-analysis which reported a positive effect of exercise training on LV volumes in post-MI patients with impaired LVEF. ADDIN EN.CITE <EndNote><Cite ExcludeAuth="1"><Author>Haykowsky</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haykowsky, M.</author><author>Scott, J.</author><author>Esch, B.</author><author>Schopflocher, D.</author><author>Myers, J.</author><author>Paterson, I.</author><author>Warburton, D.</author><author>Jones, L.</author><author>Clark, A. M.</author></authors></contributors><auth-address>University of Alberta, Edmonton, Canada. Mark.Haykowsky@ualberta.ca</auth-address><titles><title>A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling</title><secondary-title>Trials</secondary-title></titles><periodical><full-title>Trials</full-title></periodical><pages>92</pages><volume>12</volume><edition>2011/04/06</edition><keywords><keyword>Evidence-Based Medicine</keyword><keyword>Exercise Therapy</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/pathology/physiopathology/*rehabilitation</keyword><keyword>Stroke Volume</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword><keyword>*Ventricular Function, Left</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2011</year><pub-dates><date>2011</date></pub-dates></dates><isbn>1745-6215 (Electronic)
1745-6215 (Linking)</isbn><accession-num>21463531</accession-num><urls><related-urls><url> [pii]
10.1186/1745-6215-12-92</electronic-resource-num><language>eng</language></record></Cite></EndNote>8 Unique to the current study is evidence of reverse LV remodeling in post-MI patients with preserved LVEF (>45%). In this population, where LV volumes were within normal limits, the significance of medically mediated or exercise-induced reverse LV remodeling is yet to be fully evaluated. However, it is possible that improved prognosis as a result of reduced LV volumes may not be exclusive to those with pronounced LV systolic dysfunction, rather, it may also extend to less compromised patients. Abnormal hemodynamics following MI are a product of the pathological imbalance between LV pressures, cavity dimensions and wall thicknesses and can result in functional impairment. ADDIN EN.CITE <EndNote><Cite><Author>Mann</Author><Year>2012</Year><RecNum>1309</RecNum><DisplayText><style face="superscript">24</style></DisplayText><record><rec-number>1309</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s">1309</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mann, D. L.</author><author>Barger, P. M.</author><author>Burkhoff, D.</author></authors></contributors><auth-address>Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA. dmann@dom.wustl.edu</auth-address><titles><title>Myocardial recovery and the failing heart: myth, magic, or molecular target?</title><secondary-title>J Am Coll Cardiol</secondary-title></titles><periodical><full-title>J Am Coll Cardiol</full-title></periodical><pages>2465-72</pages><volume>60</volume><number>24</number><edition>2012/11/20</edition><keywords><keyword>Cardiac Resynchronization Therapy</keyword><keyword>Extracellular Matrix/pathology</keyword><keyword>Heart Failure/*physiopathology/therapy</keyword><keyword>Heart Ventricles/pathology</keyword><keyword>Humans</keyword><keyword>Muscle Cells/pathology/physiology</keyword><keyword>Myocardial Contraction/physiology</keyword><keyword>Ventricular Remodeling/*physiology</keyword></keywords><dates><year>2012</year><pub-dates><date>Dec 18</date></pub-dates></dates><isbn>1558-3597 (Electronic)
0735-1097 (Linking)</isbn><accession-num>23158527</accession-num><urls><related-urls><url>(12)04774-2 [pii]
10.1016/j.jacc.2012.06.062</electronic-resource-num><language>eng</language></record></Cite></EndNote>24 Ultimately, left untreated, this may lead to a progressive decline in cardiac function and exercise capacity, with resultant prognostic implications. ADDIN EN.CITE <EndNote><Cite><Author>Konstam</Author><Year>2011</Year><RecNum>311</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>311</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1350989779">311</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Konstam, M. A.</author><author>Kramer, D. G.</author><author>Patel, A. R.</author><author>Maron, M. S.</author><author>Udelson, J. E.</author></authors></contributors><auth-address>Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA.</auth-address><titles><title>Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment</title><secondary-title>JACC Cardiovasc Imaging</secondary-title></titles><periodical><full-title>JACC Cardiovasc Imaging</full-title></periodical><pages>98-108</pages><volume>4</volume><number>1</number><edition>2011/01/15</edition><keywords><keyword>Animals</keyword><keyword>Echocardiography</keyword><keyword>Heart Failure/diagnosis/*physiopathology/therapy</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging</keyword><keyword>Prognosis</keyword><keyword>Radionuclide Ventriculography</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2011</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1876-7591 (Electronic)</isbn><accession-num>21232712</accession-num><urls><related-urls><url>(10)00736-9 [pii]
10.1016/j.jcmg.2010.10.008</electronic-resource-num><language>eng</language></record></Cite></EndNote>6 Recent reports have indicated that, despite preserved function, 15% of post-MI patients with LVEF >45% will die or be admitted to hospital with heart failure within 20 months of their event.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbW9uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Tb2xvbW9uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48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ADDIN EN.CITE.DATA 16 It is possible that the reverse cardiac remodeling shown in the present study may prevent, or delay, the progressive decline in LV function observed in these patients. On this basis, asymptomatic patients with normal LV volumes and preserved LVEF, who are likely to return relatively quickly to activities of daily living and employment, should be encouraged to participate fully in supervised CR exercise training. NT-pro-BNP as an indicator of reverse volumetric remodelingThe raised NT-pro-BNP observed prior to exercise training in the current study likely reflects a degree of hemodynamic compromise and increased LV wall stress. ADDIN EN.CITE <EndNote><Cite><Author>Ruskoaho</Author><Year>2003</Year><RecNum>48</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>48</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">48</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ruskoaho, H.</author></authors></contributors><auth-address>Department of Pharmacology and Toxicology, Biocenter Oulu, FIN-90014 University of Oulu, Finland. heikki.ruskoaho@oulu.fi</auth-address><titles><title>Cardiac hormones as diagnostic tools in heart failure</title><secondary-title>Endocr Rev</secondary-title></titles><periodical><full-title>Endocr Rev</full-title></periodical><pages>341-56</pages><volume>24</volume><number>3</number><edition>2003/06/06</edition><keywords><keyword>Heart Failure/*diagnosis/drug therapy</keyword><keyword>Hormones/*blood</keyword><keyword>Humans</keyword><keyword>Myocardium/*metabolism</keyword><keyword>Natriuretic Peptides/blood/metabolism</keyword><keyword>Prognosis</keyword></keywords><dates><year>2003</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0163-769X (Print)
0163-769X (Linking)</isbn><accession-num>12788803</accession-num><urls><related-urls><url> Increased levels of NT-pro-BNP are related to a worse prognosis throughout the spectrum of cardiac disease.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaW08L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxSZWNO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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaW08L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxSZWNO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 EN.CITE.DATA 14 The decrease in NT-pro-BNP witnessed in the exercise training group is indicative of an improvement in the overall neurohormonal and hemodynamic environment. Due to a lack of NT-pro-BNP data in the non-exercise group, it is not possible to confirm a causal relationship between changes in NT-pro-BNP and reductions in LV volumes. However, similar associations have been previously reported with exercise training. Giallauria et al. demonstrated a positive correlation between changes in NT-pro-BNP and LVEDVI (r=0.86, P<0.001) in patients with significant LV systolic dysfunction (LVEF<45%).PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lhbGxhdXJpYTwvQXV0aG9y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ADDIN EN.CITE PEVuZE5vdGU+PENpdGUgRXhjbHVkZUF1dGg9IjEiPjxBdXRob3I+R2lhbGxhdXJpYTwvQXV0aG9y
PjxZZWFyPjIwMDg8L1llYXI+PFJlY051bT4xNzwvUmVjTnVtPjxEaXNwbGF5VGV4dD48c3R5bGUg
ZmFjZT0ic3VwZXJzY3JpcHQiPjExPC9zdHlsZT48L0Rpc3BsYXlUZXh0PjxyZWNvcmQ+PHJlYy1u
dW1iZXI+MTc8L3JlYy1udW1iZXI+PGZvcmVpZ24ta2V5cz48a2V5IGFwcD0iRU4iIGRiLWlkPSJ4
NXdkdnh6MmVmeHR6ZWVycGV1NWRlcDB0OTV6cnpyMnIwOXMiIHRpbWVzdGFtcD0iMTM0NjgzODE2
MCI+MTc8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBBcnRpY2xl
Ij4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPkdpYWxsYXVyaWEs
IEYuPC9hdXRob3I+PGF1dGhvcj5DaXJpbGxvLCBQLjwvYXV0aG9yPjxhdXRob3I+THVjY2ksIFIu
PC9hdXRob3I+PGF1dGhvcj5QYWNpbGVvLCBNLjwvYXV0aG9yPjxhdXRob3I+RGUgTG9yZW56bywg
QS48L2F1dGhvcj48YXV0aG9yPkQmYXBvcztBZ29zdGlubywgTS48L2F1dGhvcj48YXV0aG9yPk1v
c2NoZWxsYSwgUy48L2F1dGhvcj48YXV0aG9yPlBzYXJvdWRha2ksIE0uPC9hdXRob3I+PGF1dGhv
cj5EZWwgRm9ybm8sIEQuPC9hdXRob3I+PGF1dGhvcj5PcmlvLCBGLjwvYXV0aG9yPjxhdXRob3I+
Vml0YWxlLCBELiBGLjwvYXV0aG9yPjxhdXRob3I+Q2hpYXJpZWxsbywgTS48L2F1dGhvcj48YXV0
aG9yPlZpZ29yaXRvLCBDLjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1h
ZGRyZXNzPkNhcmRpYWMgUmVoYWJpbGl0YXRpb24gVW5pdCAsIERlcGFydG1lbnQgb2YgQ2xpbmlj
YWwgTWVkaWNpbmUsIENhcmRpb3Zhc2N1bGFyIGFuZCBJbW11bm9sb2dpY2FsIFNjaWVuY2VzLCBV
bml2ZXJzaXR5IG9mIE5hcGxlcyBGZWRlcmljbyBJSSwgTmFwbGVzLCBOYXBsZXMsIEl0YWx5LiBn
aWFsbGF1cmlhQGxpYmVyby5pdDwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkxlZnQgdmVu
dHJpY3VsYXIgcmVtb2RlbGxpbmcgaW4gcGF0aWVudHMgd2l0aCBtb2RlcmF0ZSBzeXN0b2xpYyBk
eXNmdW5jdGlvbiBhZnRlciBteW9jYXJkaWFsIGluZmFyY3Rpb246IGZhdm91cmFibGUgZWZmZWN0
cyBvZiBleGVyY2lzZSB0cmFpbmluZyBhbmQgcHJlZGljdGl2ZSByb2xlIG9mIE4tdGVybWluYWwg
cHJvLWJyYWluIG5hdHJpdXJldGljIHBlcHRpZGU8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+RXVy
IEogQ2FyZGlvdmFzYyBQcmV2IFJlaGFiaWw8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVy
aW9kaWNhbD48ZnVsbC10aXRsZT5FdXIgSiBDYXJkaW92YXNjIFByZXYgUmVoYWJpbDwvZnVsbC10
aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjExMy04PC9wYWdlcz48dm9sdW1lPjE1PC92b2x1bWU+
PG51bWJlcj4xPC9udW1iZXI+PGVkaXRpb24+MjAwOC8wMi8xNjwvZWRpdGlvbj48a2V5d29yZHM+
PGtleXdvcmQ+RWNob2NhcmRpb2dyYXBoeSwgRG9wcGxlcjwva2V5d29yZD48a2V5d29yZD5FeGVy
Y2lzZSBUZXN0PC9rZXl3b3JkPjxrZXl3b3JkPipFeGVyY2lzZSBUaGVyYXB5PC9rZXl3b3JkPjxr
ZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+
TGluZWFyIE1vZGVsczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxrZXl3b3JkPk1p
ZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk15b2NhcmRpYWwgSW5mYXJjdGlvbi9ibG9vZC8q
cmVoYWJpbGl0YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+TmF0cml1cmV0aWMgUGVwdGlkZSwgQnJh
aW4vKmJsb29kPC9rZXl3b3JkPjxrZXl3b3JkPlBlcHRpZGUgRnJhZ21lbnRzLypibG9vZDwva2V5
d29yZD48a2V5d29yZD5QcmVkaWN0aXZlIFZhbHVlIG9mIFRlc3RzPC9rZXl3b3JkPjxrZXl3b3Jk
PlByb3NwZWN0aXZlIFN0dWRpZXM8L2tleXdvcmQ+PGtleXdvcmQ+UXVlc3Rpb25uYWlyZXM8L2tl
eXdvcmQ+PGtleXdvcmQ+U3lzdG9sZTwva2V5d29yZD48a2V5d29yZD5UcmVhdG1lbnQgT3V0Y29t
ZTwva2V5d29yZD48a2V5d29yZD5WZW50cmljdWxhciBEeXNmdW5jdGlvbiwgTGVmdC9ibG9vZC8q
cmVoYWJpbGl0YXRpb248L2tleXdvcmQ+PGtleXdvcmQ+VmVudHJpY3VsYXIgUmVtb2RlbGluZzwv
a2V5d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDA4PC95ZWFyPjxwdWItZGF0ZXM+PGRh
dGU+RmViPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MTc0MS04MjY3IChQcmludCkm
I3hEOzE3NDEtODI2NyAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTgyNzcxOTY8L2Fj
Y2Vzc2lvbi1udW0+PHVybHM+PHJlbGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0u
bmloLmdvdi9lbnRyZXovcXVlcnkuZmNnaT9jbWQ9UmV0cmlldmUmYW1wO2RiPVB1Yk1lZCZhbXA7
ZG9wdD1DaXRhdGlvbiZhbXA7bGlzdF91aWRzPTE4Mjc3MTk2PC91cmw+PC9yZWxhdGVkLXVybHM+
PC91cmxzPjxlbGVjdHJvbmljLXJlc291cmNlLW51bT4xMC4xMDk3L0hKUi4wYjAxM2UzMjgyZjAw
OTkwJiN4RDswMDE0OTgzMS0yMDA4MDIwMDAtMDAwMTkgW3BpaV08L2VsZWN0cm9uaWMtcmVzb3Vy
Y2UtbnVtPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48L0VuZE5vdGU+
AG==
ADDIN EN.CITE.DATA 11 Furthermore, reduced NT-pro-BNP was shown to correlate with improved early diastolic filling (E-wave) (r=-0.44, P<0.001),PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwODwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwODwvWWVh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ADDIN EN.CITE.DATA 11 E/A ratio (r=-0.59, P<0.001) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh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ADDIN EN.CITE.DATA 26 and LV elastance (r=-0.58, P<0.01).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWxmYXR0bzwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWxmYXR0bzwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+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ADDIN EN.CITE.DATA 27 The direct and indirect molecular and cellular adaptations associated with exercise training likely reduce LV wall stress and, therefore, NT-pro-BNP. Although we did not witness an improvement in diastolic filling as demonstrated previously,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwODwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HaWFsbGF1cmlhPC9BdXRob3I+PFllYXI+MjAwODwvWWVh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ADDIN EN.CITE.DATA 11, 26 this may be explained by the fact that diastolic function was preserved in our patients following MI. At baseline, indices of diastolic function were within normal limits PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OYWd1ZWg8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OYWd1ZWg8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS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ADDIN EN.CITE.DATA 28 but there was a trend towards enhanced diastolic function with exercise training, consistent with that found in ‘healthy’ individuals.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5aaWxpbnNraTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5aaWxpbnNraTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+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ADDIN EN.CITE.DATA 29 Unlike LVEDV, there was no association between the changes in NT-pro-BNP and either LVESV or LVEF. This likely reflects the cardiomyocyte stretch-related mechanism of NT-pro-BNP release. ADDIN EN.CITE <EndNote><Cite><Author>Ruskoaho</Author><Year>2003</Year><RecNum>48</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>48</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">48</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ruskoaho, H.</author></authors></contributors><auth-address>Department of Pharmacology and Toxicology, Biocenter Oulu, FIN-90014 University of Oulu, Finland. heikki.ruskoaho@oulu.fi</auth-address><titles><title>Cardiac hormones as diagnostic tools in heart failure</title><secondary-title>Endocr Rev</secondary-title></titles><periodical><full-title>Endocr Rev</full-title></periodical><pages>341-56</pages><volume>24</volume><number>3</number><edition>2003/06/06</edition><keywords><keyword>Heart Failure/*diagnosis/drug therapy</keyword><keyword>Hormones/*blood</keyword><keyword>Humans</keyword><keyword>Myocardium/*metabolism</keyword><keyword>Natriuretic Peptides/blood/metabolism</keyword><keyword>Prognosis</keyword></keywords><dates><year>2003</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0163-769X (Print)
0163-769X (Linking)</isbn><accession-num>12788803</accession-num><urls><related-urls><url> It is possible, therefore, that NT-pro-BNP may have a role as a simple and effective measure of reverse LV remodeling following CR exercise training. Reverse functional remodeling with CR exercise trainingThe positive change in LV volumes in the present study was not accompanied by a change in SV and LVEF. These data do not, therefore, agree with Haykowsky et al. who reported improvements in LV volumes (LVEDV and LVESV) alongside improved LVEF following CR exercise training. ADDIN EN.CITE <EndNote><Cite><Author>Haykowsky</Author><Year>2011</Year><RecNum>19</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="x5wdvxz2efxtzeerpeu5dep0t95zrzr2r09s" timestamp="1346838160">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haykowsky, M.</author><author>Scott, J.</author><author>Esch, B.</author><author>Schopflocher, D.</author><author>Myers, J.</author><author>Paterson, I.</author><author>Warburton, D.</author><author>Jones, L.</author><author>Clark, A. M.</author></authors></contributors><auth-address>University of Alberta, Edmonton, Canada. Mark.Haykowsky@ualberta.ca</auth-address><titles><title>A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling</title><secondary-title>Trials</secondary-title></titles><periodical><full-title>Trials</full-title></periodical><pages>92</pages><volume>12</volume><edition>2011/04/06</edition><keywords><keyword>Evidence-Based Medicine</keyword><keyword>Exercise Therapy</keyword><keyword>Humans</keyword><keyword>Myocardial Infarction/pathology/physiopathology/*rehabilitation</keyword><keyword>Stroke Volume</keyword><keyword>Time Factors</keyword><keyword>Treatment Outcome</keyword><keyword>*Ventricular Function, Left</keyword><keyword>*Ventricular Remodeling</keyword></keywords><dates><year>2011</year><pub-dates><date>2011</date></pub-dates></dates><isbn>1745-6215 (Electronic)
1745-6215 (Linking)</isbn><accession-num>21463531</accession-num><urls><related-urls><url> [pii]
10.1186/1745-6215-12-92</electronic-resource-num><language>eng</language></record></Cite></EndNote>8 In the current study, however, there was a trend towards increased LVEF in the exercise training group, whilst there was no change in the non-exercise group. It is likely that, with greater statistical power, the between groups comparison of LVEF may have proved significant. Alternatively, the mild impairment of LVEF in this cohort, as opposed to the marked dysfunction in previous studies may, by definition, limit the scope for improvement. Given that LVEF was preserved in this population, which may be suggestive of “normal” systolic function, it is important to note that SV was relatively low. We believe this disparity is driven by the inherent limitations associated with the measurement of LVEF in small left ventricles.Mechanisms underpinning reverse LV remodelingCurrent knowledge of the underpinning mechanisms responsible for reverse LV remodeling with medical therapy and exercise training is limited. However, there is evidence suggesting that the negative neurohormonal and autonomic responses associated with LV remodeling are attenuated following exercise training in heart failure patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWRlbWFuPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWRlbWFuPC9BdXRob3I+PFllYXI+MjAwNzwvWWVhcj48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ADDIN EN.CITE.DATA 30 It is well known from pharmacological trials that suppression of compensatory neurohormonal and autonomic responses can minimize LV remodeling following MI,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdCBKb2huIFN1dHRvbjwvQXV0aG9yPjxZZWFyPjIwMDM8
L1llYXI+PFJlY051bT4xMzI5PC9SZWNOdW0+PERpc3BsYXlUZXh0PjxzdHlsZSBmYWNlPSJzdXBl
cnNjcmlwdCI+MzEtMzM8L3N0eWxlPjwvRGlzcGxheVRleHQ+PHJlY29yZD48cmVjLW51bWJlcj4x
MzI5PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieDV3ZHZ4
ejJlZnh0emVlcnBldTVkZXAwdDk1enJ6cjJyMDlzIj4xMzI5PC9rZXk+PC9mb3JlaWduLWtleXM+
PHJlZi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRv
cnM+PGF1dGhvcnM+PGF1dGhvcj5TdCBKb2huIFN1dHRvbiwgTS48L2F1dGhvcj48YXV0aG9yPkxl
ZSwgRC48L2F1dGhvcj48YXV0aG9yPlJvdWxlYXUsIEouIEwuPC9hdXRob3I+PGF1dGhvcj5Hb2xk
bWFuLCBTLjwvYXV0aG9yPjxhdXRob3I+UGxhcHBlcnQsIFQuPC9hdXRob3I+PGF1dGhvcj5CcmF1
bndhbGQsIEUuPC9hdXRob3I+PGF1dGhvcj5QZmVmZmVyLCBNLiBBLjwvYXV0aG9yPjwvYXV0aG9y
cz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkJyaWdoYW0gYW5kIFdvbWVuJmFwb3M7cyBI
b3NwaXRhbCwgSGFydmFyZCBNZWRpY2FsIFNjaG9vbCwgQm9zdG9uLCBNYXNzLCBVU0EuIHN1dHRv
bm1AbWFpbC5tZWQudXBlbm4uZWR1PC9hdXRoLWFkZHJlc3M+PHRpdGxlcz48dGl0bGU+TGVmdCB2
ZW50cmljdWxhciByZW1vZGVsaW5nIGFuZCB2ZW50cmljdWxhciBhcnJoeXRobWlhcyBhZnRlciBt
eW9jYXJkaWFsIGluZmFyY3Rpb248L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+Q2lyY3VsYXRpb248
L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5DaXJjdWxh
dGlvbjwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2VzPjI1NzctODI8L3BhZ2VzPjx2b2x1
bWU+MTA3PC92b2x1bWU+PG51bWJlcj4yMDwvbnVtYmVyPjxlZGl0aW9uPjIwMDMvMDUvMDc8L2Vk
aXRpb24+PGtleXdvcmRzPjxrZXl3b3JkPkFkcmVuZXJnaWMgYmV0YS1BbnRhZ29uaXN0cy90aGVy
YXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+QW5naW90ZW5zaW4tQ29udmVydGluZyBFbnp5
bWUgSW5oaWJpdG9ycy8qdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkFudGktQXJy
aHl0aG1pYSBBZ2VudHMvdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkNhcHRvcHJp
bC90aGVyYXBldXRpYyB1c2U8L2tleXdvcmQ+PGtleXdvcmQ+Q2FyZGlvbWVnYWx5L2NvbXBsaWNh
dGlvbnMvZHJ1ZyB0aGVyYXB5PC9rZXl3b3JkPjxrZXl3b3JkPkRlbW9ncmFwaHk8L2tleXdvcmQ+
PGtleXdvcmQ+RG91YmxlLUJsaW5kIE1ldGhvZDwva2V5d29yZD48a2V5d29yZD5FY2hvY2FyZGlv
Z3JhcGh5PC9rZXl3b3JkPjxrZXl3b3JkPkVsZWN0cm9jYXJkaW9ncmFwaHkvZHJ1ZyBlZmZlY3Rz
PC9rZXl3b3JkPjxrZXl3b3JkPkVsZWN0cm9jYXJkaW9ncmFwaHksIEFtYnVsYXRvcnk8L2tleXdv
cmQ+PGtleXdvcmQ+RmVtYWxlPC9rZXl3b3JkPjxrZXl3b3JkPkZvbGxvdy1VcCBTdHVkaWVzPC9r
ZXl3b3JkPjxrZXl3b3JkPkh1bWFuczwva2V5d29yZD48a2V5d29yZD5NYWxlPC9rZXl3b3JkPjxr
ZXl3b3JkPk1pZGRsZSBBZ2VkPC9rZXl3b3JkPjxrZXl3b3JkPk11bHRpdmFyaWF0ZSBBbmFseXNp
czwva2V5d29yZD48a2V5d29yZD5NeW9jYXJkaWFsIEluZmFyY3Rpb24vY29tcGxpY2F0aW9ucy8q
ZHJ1ZyB0aGVyYXB5L3VsdHJhc29ub2dyYXBoeTwva2V5d29yZD48a2V5d29yZD5TdHJva2UgVm9s
dW1lL2RydWcgZWZmZWN0czwva2V5d29yZD48a2V5d29yZD5UYWNoeWNhcmRpYSwgVmVudHJpY3Vs
YXIvY29tcGxpY2F0aW9ucy9kaWFnbm9zaXMvKmRydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29y
ZD5UcmVhdG1lbnQgT3V0Y29tZTwva2V5d29yZD48a2V5d29yZD5WZW50cmljdWxhciBEeXNmdW5j
dGlvbiwgTGVmdC9jb21wbGljYXRpb25zLypkcnVnIHRoZXJhcHkvdWx0cmFzb25vZ3JhcGh5PC9r
ZXl3b3JkPjxrZXl3b3JkPlZlbnRyaWN1bGFyIFByZW1hdHVyZSBDb21wbGV4ZXMvY29tcGxpY2F0
aW9ucy9kaWFnbm9zaXMvKmRydWcgdGhlcmFweTwva2V5d29yZD48a2V5d29yZD5WZW50cmljdWxh
ciBSZW1vZGVsaW5nLypkcnVnIGVmZmVjdHM8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHll
YXI+MjAwMzwveWVhcj48cHViLWRhdGVzPjxkYXRlPk1heSAyNzwvZGF0ZT48L3B1Yi1kYXRlcz48
L2RhdGVzPjxpc2JuPjE1MjQtNDUzOSAoRWxlY3Ryb25pYykmI3hEOzAwMDktNzMyMiAoTGlua2lu
Zyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTI3MzI2MDY8L2FjY2Vzc2lvbi1udW0+PHVybHM+PHJl
bGF0ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9lbnRyZXovcXVlcnku
ZmNnaT9jbWQ9UmV0cmlldmUmYW1wO2RiPVB1Yk1lZCZhbXA7ZG9wdD1DaXRhdGlvbiZhbXA7bGlz
dF91aWRzPTEyNzMyNjA2PC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJl
c291cmNlLW51bT4xMC4xMTYxLzAxLkNJUi4wMDAwMDcwNDIwLjUxNzg3LkE4JiN4RDswMS5DSVIu
MDAwMDA3MDQyMC41MTc4Ny5BOCBbcGlpXTwvZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+PGxhbmd1
YWdlPmVuZzwvbGFuZ3VhZ2U+PC9yZWNvcmQ+PC9DaXRlPjxDaXRlPjxBdXRob3I+S29pdGFiYXNo
aTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+PFJlY051bT4zNzM8L1JlY051bT48cmVjb3JkPjxy
ZWMtbnVtYmVyPjM3MzwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJFTiIgZGIt
aWQ9Ing1d2R2eHoyZWZ4dHplZXJwZXU1ZGVwMHQ5NXpyenIycjA5cyIgdGltZXN0YW1wPSIxMzUx
MjQzMDI4Ij4zNzM8L2tleT48L2ZvcmVpZ24ta2V5cz48cmVmLXR5cGUgbmFtZT0iSm91cm5hbCBB
cnRpY2xlIj4xNzwvcmVmLXR5cGU+PGNvbnRyaWJ1dG9ycz48YXV0aG9ycz48YXV0aG9yPktvaXRh
YmFzaGksIE4uPC9hdXRob3I+PGF1dGhvcj5LYXNzLCBELiBBLjwvYXV0aG9yPjwvYXV0aG9ycz48
L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgTWVkaWNpbmUgYW5kIEJp
b2xvZ2ljYWwgU2NpZW5jZXMsIEd1bm1hIFVuaXZlcnNpdHkgR3JhZHVhdGUgU2Nob29sIG9mIE1l
ZGljaW5lLCAzLTM5LTIyLCBTaG93YS1tYWNoaSwgTWFlYmFzaGksIEd1bm1hIDM3MS04NTExLCBK
YXBhbi48L2F1dGgtYWRkcmVzcz48dGl0bGVzPjx0aXRsZT5SZXZlcnNlIHJlbW9kZWxpbmcgaW4g
aGVhcnQgZmFpbHVyZS0tbWVjaGFuaXNtcyBhbmQgdGhlcmFwZXV0aWMgb3Bwb3J0dW5pdGllczwv
dGl0bGU+PHNlY29uZGFyeS10aXRsZT5OYXQgUmV2IENhcmRpb2w8L3NlY29uZGFyeS10aXRsZT48
L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5OYXQgUmV2IENhcmRpb2w8L2Z1bGwtdGl0
bGU+PC9wZXJpb2RpY2FsPjxwYWdlcz4xNDctNTc8L3BhZ2VzPjx2b2x1bWU+OTwvdm9sdW1lPjxu
dW1iZXI+MzwvbnVtYmVyPjxlZGl0aW9uPjIwMTEvMTIvMDc8L2VkaXRpb24+PGtleXdvcmRzPjxr
ZXl3b3JkPkFkcmVuZXJnaWMgYmV0YS1BbnRhZ29uaXN0cy90aGVyYXBldXRpYyB1c2U8L2tleXdv
cmQ+PGtleXdvcmQ+Q2FyZGlhYyBQYWNpbmcsIEFydGlmaWNpYWw8L2tleXdvcmQ+PGtleXdvcmQ+
RGlzZWFzZSBQcm9ncmVzc2lvbjwva2V5d29yZD48a2V5d29yZD5IZWFydCBGYWlsdXJlLypkcnVn
IHRoZXJhcHkvcGF0aG9sb2d5PC9rZXl3b3JkPjxrZXl3b3JkPkhlYXJ0IFZlbnRyaWNsZXMvKnBh
dGhvbG9neTwva2V5d29yZD48a2V5d29yZD5IZWFydC1Bc3Npc3QgRGV2aWNlczwva2V5d29yZD48
a2V5d29yZD5IdW1hbnM8L2tleXdvcmQ+PGtleXdvcmQ+UmVuaW4tQW5naW90ZW5zaW4gU3lzdGVt
L2RydWcgZWZmZWN0czwva2V5d29yZD48a2V5d29yZD5TaWduYWwgVHJhbnNkdWN0aW9uPC9rZXl3
b3JkPjxrZXl3b3JkPipWZW50cmljdWxhciBSZW1vZGVsaW5nPC9rZXl3b3JkPjwva2V5d29yZHM+
PGRhdGVzPjx5ZWFyPjIwMTI8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5NYXI8L2RhdGU+PC9wdWIt
ZGF0ZXM+PC9kYXRlcz48aXNibj4xNzU5LTUwMTAgKEVsZWN0cm9uaWMpJiN4RDsxNzU5LTUwMDIg
KExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjIyMTQzMDc5PC9hY2Nlc3Npb24tbnVtPjx1
cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3YvZW50cmV6
L3F1ZXJ5LmZjZ2k/Y21kPVJldHJpZXZlJmFtcDtkYj1QdWJNZWQmYW1wO2RvcHQ9Q2l0YXRpb24m
YW1wO2xpc3RfdWlkcz0yMjE0MzA3OTwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48ZWxlY3Ry
b25pYy1yZXNvdXJjZS1udW0+bnJjYXJkaW8uMjAxMS4xNzIgW3BpaV0mI3hEOzEwLjEwMzgvbnJj
YXJkaW8uMjAxMS4xNzI8L2VsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxsYW5ndWFnZT5lbmc8L2xh
bmd1YWdlPjwvcmVjb3JkPjwvQ2l0ZT48Q2l0ZT48QXV0aG9yPkZyYWNjYXJvbGxvPC9BdXRob3I+
PFllYXI+MjAwMzwvWWVhcj48UmVjTnVtPjM5OTwvUmVjTnVtPjxyZWNvcmQ+PHJlYy1udW1iZXI+
Mzk5PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0ieDV3ZHZ4
ejJlZnh0emVlcnBldTVkZXAwdDk1enJ6cjJyMDlzIiB0aW1lc3RhbXA9IjEzNTEyNTM2ODYiPjM5
OTwva2V5PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3
PC9yZWYtdHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+RnJhY2Nhcm9sbG8sIEQu
PC9hdXRob3I+PGF1dGhvcj5HYWx1cHBvLCBQLjwvYXV0aG9yPjxhdXRob3I+SGlsZGVtYW5uLCBT
LjwvYXV0aG9yPjxhdXRob3I+Q2hyaXN0LCBNLjwvYXV0aG9yPjxhdXRob3I+RXJ0bCwgRy48L2F1
dGhvcj48YXV0aG9yPkJhdWVyc2FjaHMsIEouPC9hdXRob3I+PC9hdXRob3JzPjwvY29udHJpYnV0
b3JzPjxhdXRoLWFkZHJlc3M+TWVkaXppbmlzY2hlIEtsaW5payBkZXIgSnVsaXVzLU1heGltaWxp
YW5zLVVuaXZlcnNpdGF0IFd1cnpidXJnLCBXdXJ6YnVyZywgR2VybWFueS48L2F1dGgtYWRkcmVz
cz48dGl0bGVzPjx0aXRsZT5BZGRpdGl2ZSBpbXByb3ZlbWVudCBvZiBsZWZ0IHZlbnRyaWN1bGFy
IHJlbW9kZWxpbmcgYW5kIG5ldXJvaG9ybW9uYWwgYWN0aXZhdGlvbiBieSBhbGRvc3Rlcm9uZSBy
ZWNlcHRvciBibG9ja2FkZSB3aXRoIGVwbGVyZW5vbmUgYW5kIEFDRSBpbmhpYml0aW9uIGluIHJh
dHMgd2l0aCBteW9jYXJkaWFsIGluZmFyY3Rpb248L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+SiBB
bSBDb2xsIENhcmRpb2w8L3NlY29uZGFyeS10aXRsZT48L3RpdGxlcz48cGVyaW9kaWNhbD48ZnVs
bC10aXRsZT5KIEFtIENvbGwgQ2FyZGlvbDwvZnVsbC10aXRsZT48L3BlcmlvZGljYWw+PHBhZ2Vz
PjE2NjYtNzM8L3BhZ2VzPjx2b2x1bWU+NDI8L3ZvbHVtZT48bnVtYmVyPjk8L251bWJlcj48ZWRp
dGlvbj4yMDAzLzExLzExPC9lZGl0aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BbGRvc3Rlcm9uZSBB
bnRhZ29uaXN0cy8qcGhhcm1hY29sb2d5L3RoZXJhcGV1dGljIHVzZTwva2V5d29yZD48a2V5d29y
ZD5Bbmdpb3RlbnNpbi1Db252ZXJ0aW5nIEVuenltZSBJbmhpYml0b3JzLypwaGFybWFjb2xvZ3kv
dGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPkFuaW1hbHM8L2tleXdvcmQ+PGtleXdv
cmQ+QmxvdHRpbmcsIFdlc3Rlcm48L2tleXdvcmQ+PGtleXdvcmQ+RHJ1ZyBTeW5lcmdpc208L2tl
eXdvcmQ+PGtleXdvcmQ+RHJ1ZyBUaGVyYXB5LCBDb21iaW5hdGlvbjwva2V5d29yZD48a2V5d29y
ZD5FbmRvdGhlbGl1bSwgVmFzY3VsYXIvZHJ1ZyBlZmZlY3RzL21ldGFib2xpc208L2tleXdvcmQ+
PGtleXdvcmQ+SGVtb2R5bmFtaWNzL2RydWcgZWZmZWN0czwva2V5d29yZD48a2V5d29yZD5JbmRv
bGVzLypwaGFybWFjb2xvZ3kvdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8
L2tleXdvcmQ+PGtleXdvcmQ+TXlvY2FyZGlhbCBJbmZhcmN0aW9uL3BoeXNpb3BhdGhvbG9neTwv
a2V5d29yZD48a2V5d29yZD5OaXRyaWMgT3hpZGUgU3ludGhhc2UvbWV0YWJvbGlzbTwva2V5d29y
ZD48a2V5d29yZD5SYXRzPC9rZXl3b3JkPjxrZXl3b3JkPlNwaXJvbm9sYWN0b25lLyphbmFsb2dz
ICZhbXA7IGRlcml2YXRpdmVzLypwaGFybWFjb2xvZ3kvdGhlcmFwZXV0aWMgdXNlPC9rZXl3b3Jk
PjxrZXl3b3JkPlZlbnRyaWN1bGFyIER5c2Z1bmN0aW9uLCBMZWZ0LypkcnVnIHRoZXJhcHk8L2tl
eXdvcmQ+PGtleXdvcmQ+VmVudHJpY3VsYXIgUmVtb2RlbGluZy8qZHJ1ZyBlZmZlY3RzPC9rZXl3
b3JkPjwva2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMDM8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5O
b3YgNTwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVzPjxpc2JuPjA3MzUtMTA5NyAoUHJpbnQpJiN4
RDswNzM1LTEwOTcgKExpbmtpbmcpPC9pc2JuPjxhY2Nlc3Npb24tbnVtPjE0NjA3NDU3PC9hY2Nl
c3Npb24tbnVtPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5p
aC5nb3YvZW50cmV6L3F1ZXJ5LmZjZ2k/Y21kPVJldHJpZXZlJmFtcDtkYj1QdWJNZWQmYW1wO2Rv
cHQ9Q2l0YXRpb24mYW1wO2xpc3RfdWlkcz0xNDYwNzQ1NzwvdXJsPjwvcmVsYXRlZC11cmxzPjwv
dXJscz48ZWxlY3Ryb25pYy1yZXNvdXJjZS1udW0+UzA3MzUxMDk3MDMwMTA4MDUgW3BpaV08L2Vs
ZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjxsYW5ndWFnZT5lbmc8L2xhbmd1YWdlPjwvcmVjb3JkPjwv
Q2l0ZT48L0VuZE5vdGU+AG==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdCBKb2huIFN1dHRvbjwvQXV0aG9yPjxZZWFyPjIwMDM8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ADDIN EN.CITE.DATA 31-33 and so the same may be likely with exercise training. Further, training mediated reductions in neurohormonal activation alongside the known vascular adaptations to exercise, help normalize LV afterload.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYW1icmVjaHQ8L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFy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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYW1icmVjaHQ8L0F1dGhvcj48WWVhcj4yMDAwPC9ZZWFy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 EN.CITE.DATA 34, 35 This is clearly beneficial for reverse LV remodeling. A direct effect of exercise training on the myocardium has also been demonstrated; exercise-induced biomolecular adaptations interfere with maladaptive signaling pathways, attenuating LV hypertrophy, fibrosis and apoptosis.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZW1pPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LZW1pPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48UmVj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ADDIN EN.CITE.DATA 36-38 It is likely, therefore, that the reverse LV remodeling seen in the current study is the result of many different mechanisms.Study limitationsLimitations of the current study warrant discussion. Firstly, due to ethical constraints, participants were not randomly assigned. It is possible that this lack of randomization contributed to the baseline superiority of VO2 peak (relative to body mass) in the exercise training group. Whilst this cannot be excluded as a confounding variable, its influence on the results is likely to be minimal as the groups were well matched for all other exercise test variables. Secondly, our sample size was relatively small and third, exclusively male. Finally, the reduction in NT-pro-BNP in a sub-group of patients in the exercise group could not be directly attributed to the exercise intervention alone as this was not corroborated with NT-pro-BNP data in the non-exercise group. Future randomized studies are required to confirm these results.ConclusionsTen weeks of CR exercise training improved functional capacity and resulted in reverse LV remodeling in a population of post-MI patients with preserved LVEF (>45%). This confirms the therapeutic benefit of CR exercise training and indicates a potential contribution of cardiac adaptation to the observed reductions in cardiovascular and all-cause mortality. To date, these reductions can be only partially explained by data relating to ventilatory, skeletal muscle and vascular endothelial adaptation. Patients with normal LV volumes and preserved LVEF, who may otherwise resume normal daily activities at the expense of CR, should be actively encouraged to attend structured exercise programmes to maximize the potential clinical gains from reverse LV remodeling. References ADDIN EN.REFLIST 1. Mann DL, Bogaev R, Buckberg GD. Cardiac remodelling and myocardial recovery: lost in translation? Eur J Heart Fail 2010;12:789-96.2. Mann DL, Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation 2005;111:2837-49.3. Verma A, Meris A, Skali H, Ghali JK, Arnold JM, Bourgoun M, et al. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging 2008;1:582-91.4. Maisel A, Mueller C, Adams K, Jr., Anker SD, Aspromonte N, Cleland JG, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail 2008;10:824-39.5. Moller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction. Am Heart J 2006;151:419-25.6. Konstam MA, Kramer DG, Patel AR, Maron MS, Udelson JE. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc Imaging 2011;4:98-108.7. Cho H, Barth AS, Tomaselli GF. Basic science of cardiac resynchronization therapy: molecular and electrophysiological mechanisms. Circ Arrhythm Electrophysiol 2012;5:594-603.8. Haykowsky M, Scott J, Esch B, Schopflocher D, Myers J, Paterson I, et al. A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling. Trials 2011;12:92.9. Giallauria F, Galizia G, Lucci R, D'Agostino M, Vitelli A, Maresca L, et al. Favourable effects of exercise-based Cardiac Rehabilitation after acute myocardial infarction on left atrial remodeling. Int J Cardiol 2009;136:300-6.10. Giannuzzi P, Temporelli PL, Corra U, Gattone M, Giordano A, Tavazzi L. Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction: results of the Exercise in Left Ventricular Dysfunction (ELVD) trial. Circulation 1997;96:1790-7.11. Giallauria F, Cirillo P, Lucci R, Pacileo M, De Lorenzo A, D'Agostino M, et al. Left ventricular remodelling in patients with moderate systolic dysfunction after myocardial infarction: favourable effects of exercise training and predictive role of N-terminal pro-brain natriuretic peptide. Eur J Cardiovasc Prev Rehabil 2008;15:113-8.12. Kubo N, Ohmura N, Nakada I, Yasu T, Katsuki T, Fujii M, et al. Exercise at ventilatory threshold aggravates left ventricular remodeling in patients with extensive anterior acute myocardial infarction. Am Heart J 2004;147:113-20.13. Giallauria F, Lucci R, De Lorenzo A, D'Agostino M, Del Forno D, Vigorito C. Favourable effects of exercise training on N-terminal pro-brain natriuretic peptide plasma levels in elderly patients after acute myocardial infarction. Age Ageing 2006;35:601-7.14. Kim SA, Rhee SJ, Shim CY, Kim JS, Park S, Ko YG, et al. Prognostic value of N-terminal probrain natriuretic peptide level on admission in patients with acute myocardial infarction and preserved left ventricular ejection fraction. Coron Artery Dis 2011;22:153-7.15. Furman MI, Dauerman HL, Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Twenty-two year (1975 to 1997) trends in the incidence, in-hospital and long-term case fatality rates from initial Q-wave and non-Q-wave myocardial infarction: a multi-hospital, community-wide perspective. J Am Coll Cardiol 2001;37:1571-80.16. Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation 2005;111:3411-9.17. ACSM. Guidelines for exercise testing and prescription. Eighth edition. Philadelphia: Lippincott Williams & Wilkins; 2010.18. Ross RM. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:1451; author reply 1451.19. British Society of Echocardiography. A minimum dataset for a standard transthoracic echocardiogram. London: 2012.20. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 2015;28:1-39 e14.21. Hildebrandt P, Collinson PO, Doughty RN, Fuat A, Gaze DC, Gustafsson F, et al. Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care. Eur Heart J 2010;31:1881-9.22. Buckley JP, Furze G, Doherty P, Speck L, Connolly S, Hinton S, et al. BACPR scientific statement: British standards and core components for cardiovascular disease prevention and rehabilitation. Heart 2013;99:1069-71.23. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011;162:571-584 e572.24. Mann DL, Barger PM, Burkhoff D. Myocardial recovery and the failing heart: myth, magic, or molecular target? J Am Coll Cardiol 2012;60:2465-72.25. Ruskoaho H. Cardiac hormones as diagnostic tools in heart failure. Endocr Rev 2003;24:341-56.26. Giallauria F, De Lorenzo A, Pilerci F, Manakos A, Lucci R, Psaroudaki M, et al. Reduction of N terminal-pro-brain (B-type) natriuretic peptide levels with exercise-based cardiac rehabilitation in patients with left ventricular dysfunction after myocardial infarction. Eur J Cardiovasc Prev Rehabil 2006;13:625-32.27. Malfatto G, Branzi G, Osculati G, Valli P, Cuoccio P, Ciambellotti F, et al. Improvement in left ventricular diastolic stiffness induced by physical training in patients with dilated cardiomyopathy. J Card Fail 2009;15:327-33.28. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009;10:165-93.29. Zilinski JL, Contursi ME, Isaacs SK, Deluca JR, Lewis GD, Weiner RB, et al. Myocardial adaptations to recreational marathon training among middle-aged men. Circ Cardiovasc Imaging 2015;8:e002487.30. Gademan MG, Swenne CA, Verwey HF, van der Laarse A, Maan AC, van de Vooren H, et al. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail 2007;13:294-303.31. St John Sutton M, Lee D, Rouleau JL, Goldman S, Plappert T, Braunwald E, et al. Left ventricular remodeling and ventricular arrhythmias after myocardial infarction. Circulation 2003;107:2577-82.32. Koitabashi N, Kass DA. Reverse remodeling in heart failure--mechanisms and therapeutic opportunities. Nat Rev Cardiol Mar 2012;9:147-57.33. Fraccarollo D, Galuppo P, Hildemann S, Christ M, Ertl G, Bauersachs J. Additive improvement of left ventricular remodeling and neurohormonal activation by aldosterone receptor blockade with eplerenone and ACE inhibition in rats with myocardial infarction. J Am Coll Cardiol 2003;42:1666-73.34. Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med 2000;342:454-60.35. Hambrecht R, Fiehn E, Weigl C, Gielen S, Hamann C, Kaiser R, et al. Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 1998;98:2709-15.36. Kemi OJ, Wisloff U. Mechanisms of exercise-induced improvements in the contractile apparatus of the mammalian myocardium. Acta Physiol (Oxf) 2010;199:425-39.37. Kemi OJ, Ellingsen O, Ceci M, Grimaldi S, Smith GL, Condorelli G, et al. Aerobic interval training enhances cardiomyocyte contractility and Ca2+ cycling by phosphorylation of CaMKII and Thr-17 of phospholamban. J Mol Cell Cardiol 2007;43:354-61.38. Gielen S, Schuler G, Adams V. Cardiovascular effects of exercise training: molecular mechanisms. Circulation 2010;122:1221-38.Acknowledgements.—We would like to extend our thanks to the Cardiac Rehabilitation team at University Hospital, Coventry for their expert assistance with exercise training, and to the Pathology team for processing the blood samples. Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.Received on July 15, 2015.Accepted for publication on October 30, 2015.Epub ahead of print on November 4, 2015.Table I.—Demographic, clinical and exercise test parameters at baseline and 10 weeks.Exercise training (N.=33)Non-exercise (N.=17)BaselineWeek 10BaselineWeek 10DemographicsMale gender (N., %) 33 (100) - 17 (100) -Age (yrs) 55.8±9.2 - 56.2±10.8 -Height (m) 1.7±0.1 - 1.8±0.1 -Body mass (kg) 82.7±10.283.1±10.5 90.4±14.2 90.5±14.3BMI (kg/m2) 27.4±2.627.6±2.7 29.2±4.1 27.6±2.7BSA (m2) 2.0±0.1 2.0±0.1 2.1±0.2 2.1±0.2ClinicalSTEMI (N. %) 20 (61) - 13 (77) -Anterior (N., %) 10 (50) - 7 (54) - Inferior (N., %) 10 (50) - 6 (46) -NSTEMI (N., %) 13 (39) - 4 (23) -PCI (N., %) 33 (100) - 17 (100) -Time post MI (days) 33.7±8.9 - 35.7±7.7 -Cardiovascular medication (N. %)Beta-blockers 22 (67) - 11 (65) -ACE inhibitors 27 (82) - 13 (76) -Diuretics 7 (30) - 3 (23) -Statin 32 (97) - 17 (100) -Antiplatelet 33 (100) - 17 (100) -Hypoglycaemic 6 (18) - 3 (18) -Cardiovascular disease risk factors (N., %)Smoking 2 (6) 1 (3) 0 (0) 0 (0)Sedentary behaviour 28 (85) 3 (9) 13 (76) 12 (71)Diabetes mellitus (type II) 7 (21) - 3 (18) -Dyslipidaemia 25 (76) - 12 (71) -Hypertension 16 (48) - 10 (58) -Exercise testHRrest (bpm) 59±8 58±7 56±7 56±7BPsys (mmHg) 113±17 110±16 118±12 117±12BPdia (mmHg) 71±8 71±8 70±9 70±9VO2 peak (L/min) ? ? 2.0±0.4 2.3±0.4** 1.9±0.4 1.8±0.5VO2 peak (mL/kg/min) ? ? 24.0±4.1 §27.5±4.6** 20.8±3.1 20.2±4.1Wmax (watts) ? ? 148±27 175±30** 146±28 150±31Exercise time (mins) ? ? 8.6±1.0 9.9±1.2** 8.3±1.4 8.2±2.7VT (ml/kg/min) ? ? 12.5±2.814.6±3.5** 11.2±1.7 10.8±2.3Data as mean±SD. BMI: Body Mass Index; BSA: body surface area; STEMI: ST elevation myocardial infarction; NSTEMI: non ST elevation myocardial infarction; MI: myocardial infarction; PCI: percutaneous coronary intervention; HRrest: resting heart rate; BPsys: systolic blood pressure; BPdia: diastolic blood pressure; VO2 peak: peak oxygen uptake; Wmax: maximum workload; VT: ventilatory threshold. § P<0.05 vs. non-exercise at baseline, ? P<0.05 time effect (ANOVA), ? P<0.05 group × time interaction effect (ANOVA), **P<0.0001 vs. baseline.Table II.—Cardiac structural parameters at baseline and 10 weeks.Exercise training (N.=33)Non-exercise (N.=17)PBaselineWeek 10BaselineWeek 10LV mass (g) 209±46 217±57 234±51 217±450.29LV mass/BSA (g/m2) 106±20 109±25 115±26 105±190.24IVSd (cm) 1.3±0.2 1.3±0.2 1.4±0.3 1.3±0.20.14LVPWd (cm) 1.1±0.2 1.1±0.2 1.1±0.2 1.1±0.20.37IVSs (cm) 1.7±0.2 1.7±0.2 1.8±0.3 1.8±0.30.93LVPWs (cm) 1.5±0.3 1.5±0.2 1.5±0.3 1.5±0.30.65RWT (cm) 0.45±0.08 0.45±0.08 0.46±0.11 0.45±0.100.56LA diameter (cm) 3.7±0.6 3.6±0.7 3.9±0.5 3.9±0.40.69Data as mean±SD. LV: left ventricular; BSA: body surface area; IVSd: inter-ventricular septum in diastole; LVPWd: LV posterior wall in diastole; IVSs: inter-ventricular septum in systole; LVPWs: LV posterior wall in systole; RWT: relative wall thickness; LA: left atrium. P-value = change in outcome variables by group over time (two-way mixed model ANOVA)Table III.—Left ventricular functional parameters at baseline and 10 weeks.Exercise training (N.=33)Non-exercise (N.=17)PBaselineWeek 10BaselineWeek 10LV systolic function Fractional shortening (%) 31.9±7.2 32.1±5.3 31.9±7.2 31.5±7.30.75Stroke volume (mL) 46.8±9.5 46.3±8.3 52.9±11.9 53.1±9.80.71Lateral s’(cm/s) 8.1±2.9 8.3±2.4 9.1±2.3 8.5±3.00.27Mean s’(cm/s) 8.0±1.9 8.0±1.6 8.4±1.6 8.1±2.00.50LV diastolic functionE/A ratio 1.15±0.33 1.06±0.24 1.14±0.36 1.17±0.370.27DT (ms) 215±34 224±44 217±67 245±670.25Lateral e’(cm/s) 9.5±3.3 10.0±3.1 10.0±3.3 9.8±2.90.40Lateral a’(cm/s) 8.6±2.4 9.2±2.4 8.9±1.4 8.8±2.30.26Lateral e’/a’ ratio 1.2±0.5 1.1±0.4 1.2±0.4 1.2±0.50.39Lateral E/e’ ratio 7.3±2.6 6.6±2.0 6.6±2.0 6.2±2.80.24Mean e’(cm/s) 8.1±2.3 8.6±2.1 8.9±2.4 8.8±2.10.28Mean a’(cm/s) 8.9±1.6 9.2±1.3 8.9±1.2 8.6±1.90.17Mean e’/a’ ratio 1.0±0.3 1.0±0.2 1.0±0.3 1.1±0.40.60Mean E/e’ ratio 8.4±2.0 7.6±1.6 7.5±1.7 7.0±2.90.63Data as mean±SD. s’, peak systolic mitral annulus tissue velocity; E/A ratio: ratio of peak early (E) to late (A) :mitral inflow velocity; DT: rate of deceleration of early mitral inflow; e’: peak early diastolic mitral annulus tissue velocity; a’: peak late diastolic mitral annulus tissue velocity; e’a’. ratio, ratio of peak early to late diastolic mitral annulus tissue velocity; E/e’: ratio, ratio of peak early mitral inflow velocity to peak early diastolic mitral annulus tissue velocity. P value = change in outcome variables by group over time (two-way mixed model ANOVA).Figure 1.—Left ventricular (LV) volumetric parameters at baseline (dark grey bars) and at 10 weeks (light grey bars) in the exercise training group (solid bars) and non-exercise group (striped bars). A) LV end diastolic volume (mL); B) LV end diastolic volume/BSA (mL/cm2); C) LV end systolic volume (mL); d) LV end systolic volume/BSA (mL/cm2); E) LV ejection fraction (%). Data as mean±SD. ? P<0.05 group × time interaction effect (ANOVA), *P<0.001.Figure 2.—Correlation between the relative change (?) in NT-pro-BNP (%) and the absolute change (?) in left ventricular (LV) (A) end diastolic volume (EDV) (mL), (B) end systolic volume (ESV) (ml) and (C) ejection fraction (EF) (%) in the exercise training group. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- 90 590 maine
- association between lung function impairment and left
- involvement of endothelial dysfunction assessed by
- epithelium your guide to medical school at kku
- summary of pico ppico criteria to define the question s
- reverse left ventricular remodelling effect of cardiac
- evaluation and management of the medically complex patient
Related searches
- left ventricular hypertrophy
- left ventricular cardiac hypertrophy
- diagnosis of left ventricular hypertrophy
- causes of left ventricular hypertrophy
- thickening of the left ventricular wall
- ekg of left ventricular hypertrophy
- cause of left ventricular hypertrophy
- treatment of left ventricular hypertrophy
- treatment of left ventricular dysfunction
- thickening of left ventricular wall
- symptoms of left ventricular hypertrophy
- treatment of left ventricular thrombus