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Role of exercise training on autonomic and inflammatory profile after acute coronary syndromes

Session Poster session 4

Speaker Jose Carlos Nicolau

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : H G Moreira (Sao Paulo,BR), DG Martinez (Sao Paulo,BR), RL Lage (Sao Paulo,BR), L Ferreira-Santos (Sao Paulo,BR), CE Negrao (Sao Paulo,BR), MUPB Rondon (Sao Paulo,BR), JC Nicolau (Sao Paulo,BR)

H.G. Moreira1 , D.G. Martinez1 , R.L. Lage1 , L. Ferreira-Santos1 , C.E. Negrao1 , M.U.P.B. Rondon1 , J.C. Nicolau1 , 1Heart Institute (InCor) - University of Sao Paulo Faculty of Medicine (FMUSP) - Sao Paulo - Brazil ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 714

Background: Both sympathetic hyperactivity and increased inflammatory responses reported in patients with acute coronary syndrome (ACS) have been associated with clinical adverse outcomes. Additionally, exercise training is associated with reductions in mortality and reinfarction after ACS, playing an important role in secondary prevention.

Purpose: The objective was to evaluate the long-term effects of exercise training in patients with MI regarding the sympathetic and inflammatory activity.

Methods: Thirty-four patients with uncomplicated ACS were evaluated; their mean age was 51.7±7.0 years, 79.4% were male, and 94.1% had myocardial infarction. After 30 days of hospital discharge, 14 patients were assign in a program of cardiac rehabilitation consisted of three 60-minute exercise sessions per week for 5 months. The remained 20 patients remained untrained. All patients underwent muscle sympathetic nerve activity (MSNA) analysis; on the same day, blood samples were collected for ultrasensitive C-reactive protein (usCRP), interleukin-6 (IL-6) and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity level measurements in the 30-day after discharge. MSNA was recorded directly from the peroneal nerve using the microneurography technique. The measurements were repeated at 3 and 6 months after hospitalization.

Results: After 30 days of hospitalization, the median usCRP level was 1.67 (IQR 0.61; 3.15) mg/L, the median IL-6 level was 2.46 (IQR 1.90; 4.40), the mean Lp-PLA2 activity level was 162.8±44.5 nmol/min/mL, and the mean MSNA rate was 63.0±14.54 bursts/100 heart beats. Exercise training had no significant influence on usCRP and Lp-PLA2 levels, but significantly reduced the IL-6 levels at 6 months (P=0.005). Similarly, MSNA was significantly reduced from 66.3±9.6 at 1 month to 46.8±16.9 bursts/100 heart beats at 6-months after ACS in the trained group (P=0.002), but not in the untrained group (61.0±15.4 to 68.0±18.0 bursts/100 heart beats, respectively, P=0.125). The untrained group had no significant differences in the inflammatory biomarkers over the follow-up.

Conclusions: Exercise training reduces sympathetic nerve activity and inflammation in patients after ACS. These changes can partially explain the improved prognosis after ACS in patients who underwent cardiac rehabilitation. These findings highlight the clinical importance of this non-pharmacological therapy in post-ACS patients.

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