Physical therapy intervention in patients with non-cardiac chest pain following a recent cardiac event: A randomized controlled trial.

OBJECTIVES: To assess the effect of two different physical therapy interventions in patients with stable coronary heart disease and non-cardiac chest pain. METHODS: A randomized controlled trial was carried out at a university hospital in Norway. A total of 30 patients with known and stable coronary heart disease and self-reported persistent chest pain reproduced by palpation of intercostal trigger points were participating in the study. The intervention was deep friction massage and heat pack versus heat pack only. The primary outcome was pain intensity after the intervention period and 3 months after the last treatment session, measured by Visual Analogue Scale, 0 to 100. Secondary outcome was health-related quality of life. RESULTS: Treatment with deep friction massage and heat pack gave significant pain reduction compared to heat pack only (-17.6, 95% confidence interval: -30.5, -4.7; p < 0.01), and the reduction was persistent at 3 months' follow-up (-15.2, 95% confidence interval: -28.5, -1.8; p = 0.03). Health-related quality of life improved in all three domains in patients with no significant difference between groups. CONCLUSION: Deep friction massage combined with heat pack is an efficient treatment of musculoskeletal chest pain in patients with stable coronary heart disease.

Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study.

OBJECTIVE: Exercise capacity strongly predicts survival and aerobic interval training (AIT) increases peak oxygen uptake effectively in cardiac patients. Usual care in Norway provides exercise training at the hospitals following myocardial infarction (MI), but the effect and actual intensity of these rehabilitation programmes are unknown. DESIGN: Randomized controlled trial. SETTING: Hospital cardiac rehabilitation. SUBJECTS: One hundred and seven patients, recruited two to 12 weeks after MI, were randomized to usual care rehabilitation or treadmill AIT. INTERVENTIONS: Usual care aerobic group exercise training or treadmill AIT as 4 × 4 minutes intervals at 85-95% of peak heart rate. Twice weekly exercise training for 12 weeks. MAIN MEASURES: The primary outcome measure was peak oxygen uptake. Secondary outcome measures were endothelial function, blood markers of cardiovascular disease, quality of life, resting heart rate, and heart rate recovery. RESULTS: Eighty-nine patients (74 men, 15 women, 57.4 ± 9.5 years) completed the programme. Peak oxygen uptake increased more (P = 0.002) after AIT (from 31.6 ± 5.8 to 36.2 ± 8.6 mL·kg(-1)·min(-1), P < 0.001) than after usual care rehabilitation (from 32.2 ± 6.7 to 34.7 ± 7.9 mL·kg(-1)·min(-1), P < 0.001). The AIT group exercised with significantly higher intensity in the intervals compared to the highest intensity in the usual care group (87.3 ± 3.9% versus 78.7 ± 7.2% of peak heart rate, respectively, P < 0.001). Both programmes increased endothelial function, serum adiponectin, and quality of life, and reduced serum ferritin and resting heart rate. High-density lipoprotein cholesterol increased only after AIT. CONCLUSIONS: AIT increased peak oxygen uptake more than the usual care rehabilitation provided to MI patients by Norwegian hospitals.

Maternal left ventricular and endothelial functions in preeclampsia.

OBJECTIVE: To compare maternal left ventricular and endothelial functions in preeclampsia and normal pregnancy, during pregnancy and after delivery. DESIGN: Observational study with follow-up. SETTING: University hospital and midwife-led antenatal care center. SAMPLES: Twenty untreated women with preeclampsia and 20 women with normal pregnancy, matched for gestational age and parity. METHODS: The women were examined during pregnancy and three months after delivery. Left ventricular function was assessed by echocardiography, including tissue-Doppler imaging. Endothelial function was assessed by measuring flow-mediated dilation of the brachial artery. MAIN OUTCOME MEASURES: Early diastolic mitral annular tissue velocity, "e", peak systolic tissue velocity, "S", and flow-mediated dilation. RESULTS: The diastolic function was reduced in preeclampsia, with lower "e", and there was a higher ratio of early diastolic mitral inflow velocity and early diastolic mitral annular velocity, "E/e". Early diastolic mitral inflow deceleration time and isovolumetric relaxation time were similar between the groups, suggesting pseudonormalization and increased filling pressures in preeclampsia. "S" was lower in the preeclampsia group during pregnancy. Both diastolic and systolic left ventricular functions normalized postpartum. The flow-mediated dilation was impaired in the preeclampsia group both during pregnancy and three months after delivery. CONCLUSIONS: The maternal left ventricular function was impaired during preeclampsia but had normalized three months after delivery. The endothelial function, measured by flow-mediated dilation, was impaired in the preeclampsia group as compared with the normal pregnancy group both during pregnancy and three months after delivery.

Even low level of physical activity is associated with reduced mortality among people with metabolic syndrome, a population based study (the HUNT 2 study, Norway).

BACKGROUND: Low levels of physical activity may increase the risk of developing metabolic syndrome, a cluster of metabolic factors that are associated with the risk of premature death. It has been suggested that physical activity may reduce the impact of factors associated with metabolic syndrome, but it is not known whether physical activity may reduce mortality in people with metabolic syndrome. METHODS: In a prospective study of 50,339 people, 13,449 had metabolic syndrome at baseline and were followed up for ten years to assess cause-specific mortality. The population was divided into two age groups: those younger than 65 years of age and those older than age 65. Information on their physical activity levels was collected at baseline. RESULTS: Metabolic syndrome was associated with higher mortality from all causes (hazard ratio (HR) 1.35, 95% confidence interval (95% CI) 1.20 to 1.52) and from cardiovascular causes (HR 1.78, 95% CI 1.39 to 2.29) in people younger than 65 years old than among other populations. In older people, there was no overall association of metabolic syndrome with mortality. People with metabolic syndrome who reported high levels of physical activity at baseline were at a reduced risk of death from all causes compared to those who reported no physical activity, both in the younger age group (HR 0.52, 95% CI 0.37 to 0.73) and in the older age group (HR 0.59, 95% CI 0.47 to 0.74). CONCLUSION: Among people with metabolic syndrome, physical activity was associated with reduced mortality from all causes and from cardiovascular causes. Compared to inactivity, even low levels of physical activity were associated with reduced mortality.

Psychometric properties of the Norwegian MacNew Heart Disease health-related quality of life inventory.

BACKGROUND: MacNew is a health-related quality of life (HQOL) inventory for patients with ischaemic heart disease and includes three domains; emotional, physical and social. The MacNew gives new opportunities to compare directly patients with the three major ischaemic heart diagnoses, angina, myocardial infarction and heart failure. However, this inventory has not earlier been evaluated in Norwegian. OBJECTIVE: The purpose of this study was to validate the Norwegian version of the disease-specific HQOL inventory MacNew by assessing the measurement model, internal consistent reliability and test-retest and convergent validity. METHOD: Patients with ischaemic heart disease (n=124; angina pectoris, n=53; myocardial infarction, n=35; and heart failure; n=36) participated in this cross-sectional study. Patients completed the self-administered MacNew and the generic HQOL-instrument SF-36. The MacNew and the SF-36 were repeated 2-3 weeks later (test-retest) by 17 patients. RESULTS: The psychometric properties were satisfactory to good. The construct validity assessed by factor analysis explained 61.5% of the variance. The internal consistent reliability was high (exceeded 0.90 in all domains). The test-retest analysis showed equivalent results demonstrating good reproducible properties. The convergent validity within each domain was evaluated with correlation analysis, demonstrating correlations of 0.74, 0.69 and 0.71 on the emotional, physical and social domains, respectively. CONCLUSION: The Norwegian version of the MacNew inventory demonstrated satisfactory to good psychometric properties and can be recommended for evaluating HQOL for patients with heart diseases in clinical studies.

The association of metabolic clustering and physical activity with cardiovascular mortality: the HUNT study in Norway.

BACKGROUND: In asymptomatic populations, physical activity is inversely associated with the risk of cardiovascular death, but it is not known if physical activity compensates for adverse effects of multiple cardiovascular risk factors. The aim of this study was to assess if the positive association of a clustering of cardiovascular risk factors (CRFs) with cardiovascular disease (CVD) mortality could be weakened by exercise training. METHODS: We followed 53 542 individuals who were free from known CVD, among which 3751 had CRF, from baseline between 1984 and 1986 until the date of death from any cause, or until the end of follow-up (31 December 2004). We used the Cox proportional hazards model to estimate HR of cardiovascular death. RESULTS: The HR of death from CVD among people with CRF was 1.38 (95% CI 1.28 to 1.48) compared to those without CRF. The association was stronger among women than in men. In people with CRF, cardiovascular mortality was inversely related to physical activity: risk was 24% lower (HR 0.76, 95% CI 0.61 to 0.95) in the physically active compared to the inactive group. Compared to inactive people without CRF, people with CRF who reported no activity had 41% higher risk of cardiovascular death (HR 1.41, 95% CI 1.16 to 1.70). CONCLUSION: These data show that individuals with CRF are at greater risk of premature cardiovascular death compared to people without CRF, and that the risk of people with CRF who were physically active appears to be comparable to that of inactive individuals without CRF.

Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life.

BACKGROUND: Peak oxygen uptake (Vo(2peak)) strongly predicts mortality in cardiac patients. We compared the effects of aerobic interval training (AIT) versus moderate continuous training (MCT) on Vo(2peak) and quality of life after coronary artery bypass grafting (CABG). METHODS: Fifty-nine CABG patients were randomized to either AIT at 90% of maximum heart rate or MCT at 70% of maximum heart rate, 5 d/wk, for 4 weeks at a rehabilitation center. Primary outcome was Vo(2peak), at baseline, after rehabilitation (4 weeks), and after 6 months of home-based exercise (6 months). RESULTS: Vo(2peak) increased between baseline and 4 weeks in AIT (27.1 +/- 4.5 vs 30.4 +/- 5.5 mL.kg(-1).min(-1), P < .001) and MCT (26.2 +/- 5.2 vs 28.5 +/- 5.6 mL.kg(-1).min(-1), P < .001; group difference, not significant). Aerobic interval training increased Vo(2peak) between 4 weeks and 6 months (30.4 +/- 5.5 vs 32.2 +/- 7.0 mL.kg(-1).min(-1), P < .001), with no significant change in MCT (28.5 +/- 5.6 vs 29.5 +/- 5.7 mL.kg(-1).min(-1)). Quality of life improved in both groups from baseline to 4 weeks, remaining improved at 6 months. There were no changes in echocardiographic systolic and diastolic left ventricular function. Adiponectin increased between 4 weeks and 6 months in both groups (group differences, not significant). CONCLUSIONS: Four weeks of intense training increased Vo(2peak) significantly after both AIT and MCT. Six months later, the AIT group had a significantly higher Vo(2peak) than MCT. The results indicate that AIT and MCT increase Vo(2peak) similarly in the short term, but with better long-term effect of AIT after CABG.

Left ventricular myocardial function during the acute phase of a subarachnoid haemorrhage.

OBJECTIVES: Previous reports suggest that left myocardial ventricular function changes during the course of a subarachnoid haemorrhage. The aim of this study was to evaluate left myocardial ventricular function with tissue Doppler echocardiography at two time points during the acute phase of a subarachnoid haemorrhage. DESIGN: Eighteen consecutive patients (median 52 years, range 33-74) with spontaneous subarachnoid haemorrhage and no history of heart disease were examined at 1-5 days and at 6-11 days following ictus. Eighteen control subjects were included for comparison (52 years, 32-72). RESULTS: Tissue Doppler indices of left ventricular contractility were higher in patients than in controls at both examinations (p<0.001). Indices of left ventricular stroke volume were elevated compared to controls at examination 1 (p<0.05), but not at examination 2. Early diastolic relaxation rate decreased from examination 1 to 2 (p=0.001). Three patients had increased troponin T (range 0.010-0.131 microg/l). CONCLUSION: In patients with subarachnoid haemorrhage, systolic and diastolic function is increased compared to healthy controls, suggesting a hyperdynamic and hypervolemic circulation.

Regional myocardial long-axis strain and strain rate measured by different tissue Doppler and speckle tracking echocardiography methods: a comparison with tagged magnetic resonance imaging.

AIMS: Compare four different echocardiographic methods, based on tissue Doppler imaging (TDI) and speckle tracking (ST) separately or combined, for long-axis strain and strain rate (SR) measurements, using magnetic resonance imaging (MRI) tagging as a reference. METHODS AND RESULTS: In 21 subjects (10 with myocardial infarction) peak systolic strain and systolic and early diastolic SR were measured by four different echo methods: (i) two-dimensional (2D) strain (B-mode); (ii) ST (custom software) of segment end-points (B-mode); (iii) similar to (ii), but combining ST with tissue Doppler tracking; (iv) strain from tissue Doppler velocity gradients (VG). Agreement with MRI tagging was better for strain than for SR. Ninety-five per cent limits of agreement were wider for the TDI-VG method, and 2D strain showed negative bias compared with MRI tagging and the other echo methods. Reproducibility was better for 2D strain than for MRI tagging and the other echo methods. CONCLUSION: ST alone or combined with TDI seems to be suitable for automated measurements of regional myocardial deformation. The study gives important information on the strengths and weaknesses of the different methods, which is important for further development to increase accuracy and applicability.

Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents.

The aim of the present study was to compare the effects of a multidisciplinary approach (MTG) and aerobic interval training (AIT) on cardiovascular risk factors in overweight adolescents. A total of 62 overweight and obese adolescents from Trøndelag County in Norway, referred to medical treatment at St Olav's Hospital, Trondheim, Norway, were invited to participate. Of these, 54 adolescents (age, 14.0 +/- 0.3 years) were randomized to either AIT (4 x 4 min intervals at 90% of maximal heart rate, each interval separated by 3 min at 70%, twice a week for 3 months) or to MTG (exercise, dietary and psychological advice, twice a month for 12 months). Follow-up testing occurred at 3 and 12 months. VO(2max) (maximal oxygen uptake) increased more after AIT compared with MTG, both at 3 months (11 compared with 0%; P<0.01) and 12 months (12 compared with -1%; P<0.01). AIT enhanced endothelial function compared with MTG at both 3 months (absolute change, 5.1 compared with 3.9%; P<0.01) and 12 months (absolute change, 6.3 compared with 1.0%; P<0.01). AIT was favourable compared with MTG in reducing BMI (body mass index), percentage of fat, MAP (mean arterial blood pressure) and increasing peak oxygen pulse. In addition, AIT induced a more favourable regulation of blood glucose and insulin compared with MTG. In conclusion, the novel findings of the present proof-of-concept study was that 3 months of twice weekly high-intensity exercise sessions reduced several known cardiovascular risk factors in obese adolescents more than that observed after a multitreatment strategy, which was initiated as hospital treatment. Follow-up at 12 months confirmed that AIT improved or maintained these risk factors to a better degree than MTG.

Upright bicycle exercise echocardiography in patients with myocardial infarction shows lack of diastolic, but not systolic, reserve: a tissue Doppler study.

AIMS: The aim of this feasibility study was to compare systolic and diastolic left ventricular (LV) function during upright bicycle exercise in patients with chronic myocardial infarction (MI). METHODS AND RESULTS: Eighteen patients with first-time MI and no signs of heart failure at rest underwent upright bicycle exercise at 25, 50, and 75 W, and were compared with 18 age-matched controls. Systolic (S') and early (E') mitral annular velocities and early mitral filling velocity (E) were measured at each stage. LV ejection fraction was lower in the MI group (46 vs. 54%, P < 0.01), while end-diastolic volumes were similar. S' was lower in the MI patients, but increased during exercise in both groups. E' was similar at rest, but increased in the control group only. Early mitral filling (E) increased in both groups, thus the E/E' ratio increased during exercise in the MI group only. Heart rate was similar in both groups. CONCLUSIONS: Upright exercise echocardiography is feasible and can unmask early diastolic dysfunction and increased LV filling pressures in patients with small prior MIs.

Physical activity and mortality in men and women with coronary heart disease: a prospective population-based cohort study in Norway (the HUNT study).

BACKGROUND: Patients with established coronary heart disease (CHD) are encouraged to be physically active to prevent disease progression and to prolong life. The amount and intensity of exercise required for risk reduction in patients with CHD is not yet fully resolved. DESIGN: Population-based prospective cohort study with 18 years of follow-up. METHODS: A linkage between a Norwegian population-based study (Nord-Trøndelag health study) and the Cause of Death Registry at Statistics Norway. Exercise amount and intensity were measured at baseline (1984-1986) in 2137 men and 1367 women with CHD. RESULTS: During 18 years of follow-up, 1741 (81.6%) men and 1100 (80.5%) women died. Compared with the reference category (no activity), one weekly exercise session was associated with a lower all-cause mortality, both in men (relative risk 0.80, 95% confidence interval 0.68-0.94) and women (relative risk 0.68, 95% confidence interval 0.55-0.83). This inverse association became stronger with increasing frequency (P< or =0.001 for men and women). Those who reported moderate or high-intensity exercise had a somewhat lower risk of death than those who exercised with low intensity. CONCLUSION: Exercise training reduced all-cause and cardiovascular mortality in men and women with CHD. This study adds significantly to the sparse literature regarding prospective data on physical activity, exercise intensity and mortality in CHD patients.

Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study.

BACKGROUND: Individuals with the metabolic syndrome are 3 times more likely to die of heart disease than healthy counterparts. Exercise training reduces several of the symptoms of the syndrome, but the exercise intensity that yields the maximal beneficial adaptations is in dispute. We compared moderate and high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with the metabolic syndrome. METHODS AND RESULTS: Thirty-two metabolic syndrome patients (age, 52.3+/-3.7 years; maximal oxygen uptake [o(2)max], 34 mL x kg(-1) x min(-1)) were randomized to equal volumes of either moderate continuous moderate exercise (CME; 70% of highest measured heart rate [Hfmax]) or aerobic interval training (AIT; 90% of Hfmax) 3 times a week for 16 weeks or to a control group. o(2)max increased more after AIT than CME (35% versus 16%; P<0.01) and was associated with removal of more risk factors that constitute the metabolic syndrome (number of factors: AIT, 5.9 before versus 4.0 after; P<0.01; CME, 5.7 before versus 5.0 after; group difference, P<0.05). AIT was superior to CME in enhancing endothelial function (9% versus 5%; P<0.001), insulin signaling in fat and skeletal muscle, skeletal muscle biogenesis, and excitation-contraction coupling and in reducing blood glucose and lipogenesis in adipose tissue. The 2 exercise programs were equally effective at lowering mean arterial blood pressure and reducing body weight (-2.3 and -3.6 kg in AIT and CME, respectively) and fat. CONCLUSIONS: Exercise intensity was an important factor for improving aerobic capacity and reversing the risk factors of the metabolic syndrome. These findings may have important implications for exercise training in rehabilitation programs and future studies.

Endothelial function in highly endurance-trained men: effects of acute exercise.

Exercise training reverses endothelial dysfunction, but the effect in young, healthy subjects is less clear. We determined the influence of maximal oxygen uptake (VO2max) and a single bout of high-intensity exercise on flow-mediated dilatation (FMD), brachial artery diameter, peak blood flow, nitric oxide (NO) bioavailability, and antioxidant status in highly endurance-trained men and their sedentary counterparts. Ten men athletes (mean +/- SEM age 23.5 +/- 0.9 years, height 182.6 +/- 2.4 cm, weight 72.5 +/- 2.4 kg, VO2max 75.9 +/- 0.8 mL.kg.min) and seven healthy controls (age 25.4 +/- 1.2 years, height 183.9 +/- 3.74 cm, weight 92.8 +/- 3.9 kg, VO2max 47.7 +/- 1.7 mL.kg.min) took part in the study. FMD, brachial artery diameter, and peak blood flow were measured using echo-Doppler before, 1 hour, 24 hours, and 48 hours after a single bout of interval running for 5 x 5 minutes at 90% of maximal heart rate. NO bioavailability and antioxidant status in blood were measured at all time points. Maximal arterial diameter and peak flow were 10-15% (P < 0.02) and 28-35% (P < 0.02) larger, respectively, in athletes vs. controls at all time points, and similar FMD were observed, apart from a transient decay of FMD in athletes 1 hour post exercise. NO bioavailability increased significantly after exercise in both groups and decreased to baseline levels after 24 hours in controls but remained increased 80% and 93% above baseline 24 and 48 hours post exercise in athletes. Antioxidant status was equal in the two groups at baseline and increased by approximately 10% 1 hour post exercise, an effect that lasted for 24 hours. Athletes had larger arterial diameter but similar FMD as untrained subjects, i.e., athletes had larger capacity for blood transport compared with their untrained counterparts. The observed FMD, bioavailability of NO, and antioxidant status in blood were highly dependent on the time elapsed after the exercise session.

High-intensity aerobic exercise improves diastolic function in coronary artery disease.

OBJECTIVE: To study the effect of aerobic treadmill exercise training with different intensity on left ventricular (LV) function in patients with stable coronary artery disease, using Strain Rate- and Tissue Doppler Imaging. DESIGN: Seventeen patients were randomly assigned to either moderate (50-60% of peak oxygen uptake (VO(2peak)) or high intensity exercise (80-90% of VO(2peak)) for 10 weeks. RESULTS: The increase of VO(2peak) was significantly higher (p=0.01) in the high intensity group (17 vs. 8%). Mean LV early diastolic strain rate increased in the high, but not in the moderate, intensity group. For systolic strain rate or mitral annular velocities there were no change after training in either group. CONCLUSIONS: Aerobic treadmill exercise improves early diastolic relaxation in patients with stable coronary artery disease, measured by the mean LV early diastolic strain rate.

Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults.

Regular exercise training is recognized as a powerful tool to improve work capacity, endothelial function and the cardiovascular risk profile in obesity, but it is unknown which of high-intensity aerobic exercise, moderate-intensity aerobic exercise or strength training is the optimal mode of exercise. In the present study, a total of 40 subjects were randomized to high-intensity interval aerobic training, continuous moderate-intensity aerobic training or maximal strength training programmes for 12 weeks, three times/week. The high-intensity group performed aerobic interval walking/running at 85-95% of maximal heart rate, whereas the moderate-intensity group exercised continuously at 60-70% of maximal heart rate; protocols were isocaloric. The strength training group performed 'high-intensity' leg press, abdominal and back strength training. Maximal oxygen uptake and endothelial function improved in all groups; the greatest improvement was observed after high-intensity training, and an equal improvement was observed after moderate-intensity aerobic training and strength training. High-intensity aerobic training and strength training were associated with increased PGC-1alpha (peroxisome-proliferator-activated receptor gamma co-activator 1alpha) levels and improved Ca(2+) transport in the skeletal muscle, whereas only strength training improved antioxidant status. Both strength training and moderate-intensity aerobic training decreased oxidized LDL (low-density lipoprotein) levels. Only aerobic training decreased body weight and diastolic blood pressure. In conclusion, high-intensity aerobic interval training was better than moderate-intensity aerobic training in improving aerobic work capacity and endothelial function. An important contribution towards improved aerobic work capacity, endothelial function and cardiovascular health originates from strength training, which may serve as a substitute when whole-body aerobic exercise is contra-indicated or difficult to perform.

Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study.

BACKGROUND: Exercise training reduces the symptoms of chronic heart failure. Which exercise intensity yields maximal beneficial adaptations is controversial. Furthermore, the incidence of chronic heart failure increases with advanced age; it has been reported that 88% and 49% of patients with a first diagnosis of chronic heart failure are >65 and >80 years old, respectively. Despite this, most previous studies have excluded patients with an age >70 years. Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfarction heart failure. METHODS AND RESULTS: Twenty-seven patients with stable postinfarction heart failure who were undergoing optimal medical treatment, including beta-blockers and angiotensin-converting enzyme inhibitors (aged 75.5+/-11.1 years; left ventricular [LV] ejection fraction 29%; VO2peak 13 mL x kg(-1) x min(-1)) were randomized to either moderate continuous training (70% of highest measured heart rate, ie, peak heart rate) or aerobic interval training (95% of peak heart rate) 3 times per week for 12 weeks or to a control group that received standard advice regarding physical activity. VO2peak increased more with aerobic interval training than moderate continuous training (46% versus 14%, P<0.001) and was associated with reverse LV remodeling. LV end-diastolic and end-systolic volumes declined with aerobic interval training only, by 18% and 25%, respectively; LV ejection fraction increased 35%, and pro-brain natriuretic peptide decreased 40%. Improvement in brachial artery flow-mediated dilation (endothelial function) was greater with aerobic interval training, and mitochondrial function in lateral vastus muscle increased with aerobic interval training only. The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups. No changes occurred in the control group. CONCLUSIONS: Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity, endothelial function, and quality of life in patients with postinfarction heart failure. These findings may have important implications for exercise training in rehabilitation programs and future studies.

Automated analysis of myocardial deformation at dobutamine stress echocardiography: an angiographic validation.

OBJECTIVES: We investigated the accuracy of automated analysis of myocardial deformation during dobutamine stress echocardiography (DSE). BACKGROUND: The time required for segmental measurement of strain rate imaging (SRI) limits its feasibility for quantification of DSE. METHODS: Myocardial deformation was assessed at DSE in 197 patients, 76 with and 61 without coronary artery disease (CAD) at angiography, and 60 at low risk of CAD. Automated deformation analysis was based on velocity gradient and segment length methods of measuring longitudinal motion within a region of interest tracked through the cardiac cycle. Results were compared with independent wall motion scoring (WMS). Patients were randomly divided; group A (n = 69) established optimal cutoffs for the parameters and group B (n = 68) tested their accuracy. RESULTS: The feasibility of WMS exceeded that of both SRI methods at rest and at peak stress. In group A, the area under the receiver-operating characteristics curve of the peak systolic strain rate was 0.90 by both methods, and the optimal cutoffs for detection of CAD were -1.3 (velocity gradient) and -1.2 s(-1) (segment length). The areas under the receiver-operating characteristics curves for end-systolic strain were less (0.87) by both methods, with respective cutoffs of 9% and 8%. In group B, the velocity and segment length methods had respective sensitivities of 87% and 84% for SR, and 87% and 88% for end-systolic strain. Both significantly exceeded that of WMS in the same group (75%). CONCLUSIONS: Automated analysis of myocardial deformation at DSE is feasible and accurate, and may increase the sensitivity of expert conventional reading.

[Exercise training in cardiovascular diseases]. / Fysisk trening ved hjerte- og karsykdommer.

BACKGROUND: Physical activity and exercise training are effective in prevention, treatment and rehabilitation of cardiovascular disease, but the dose-response relationship is insufficiently documented. METHOD: The manuscript is based on existing guidelines and searches in Pubmed for the period 1990-2006. RESULTS AND INTERPRETATION: Exercise training improves maximum oxygen consumption and prognosis in patients with cardiovascular disease. A single weekly bout of exercise reduces mortality from stroke and ischemic heart disease, but larger doses may provide additional protection. In patients with coronary heart disease, high intensity exercise seems to be more effective in improving maximal oxygen consumption than moderate exercise, but it is not known if such exercise is also more effective in improving survival. Further studies are also required to establish the safety of such exercise. Exercise has few contraindications, but patients should be screened in advance with an exercise-ECG. Future studies should to a larger extent include female, elderly and high-risk patients, and be precise in prescribing and reporting exercise intensity, duration and frequency. Maximum oxygen consumption is an accurate measure of cardiovascular fitness and a strong and independent prognostic marker for survival, both in patients and healthy subjects.

Incremental value of strain rate imaging to wall motion analysis for prediction of outcome in patients undergoing dobutamine stress echocardiography.

BACKGROUND: Wall motion score at dobutamine stress echocardiography is an independent predictor of mortality. We sought to determine whether quantification of DSE by strain rate imaging was incremental to wall motion score for predicting outcome. METHODS AND RESULTS: In 646 patients undergoing dobutamine stress echocardiography for the evaluation of known or suspected coronary disease, customized software was used to automatically measure peak systolic strain rate (SR(s)) and end-systolic strain (S(es)) in 18 segments. Results were expressed as the number of abnormal segments and the mean SR(s) and S(es) per patient. All-cause mortality was identified over 7 years of follow-up (mean, 5.2+/-1.5 years). Contributions of clinical, wall motion, and SR(s) and S(es) data to outcome were analyzed with Cox models, which also were used to define cut points for SR(s) and S(es). Ischemia (new or worsening wall motion abnormalities) was detected in 45%, and 39% had a previous myocardial infarction. In patients with no ischemia, annualized mortality without and with previous myocardial infarction were 2% and 3% compared with 5% in patients with ischemia. Peak wall motion score index, mean SR(s), segmental S(es), and segmental SR(s) were all predictors of mortality, but only segmental SR(s) (hazard ratio, 3.6; 95% CI, 1.7 to 7.2) was independently predictive. In sequential Cox models, the model based on clinical data (overall chi2, 12.7) was improved by peak wall motion score index (18.4, P=0.002) and further increased by either segmental SR(s) (31.8, P<0.001) or mean SR(s) (25.7, P=0.009). CONCLUSIONS: Segmental analysis by SR(s), derived from automated strain rate imaging analysis of dobutamine stress echocardiography response, offers prognostic information that is independent and incremental to standard wall motion score index.