title: Effect of high-intensity interval training on progression of cardiac allograft vasculopathy.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) is a progressive form of atherosclerosis occurring in heart transplant (HTx) recipients, leading to increased morbidity and mortality. Given the atheroprotective effect of exercise on traditional atherosclerosis, we hypothesized that high-intensity interval training (HIIT) would reduce the progression of CAV among HTx recipients.
  
  
  METHODS
  Forty-three cardiac allograft recipients (mean ± SD age 51 ± 16 years; 67% men; time post-HTx 4.0 ± 2.2 years), all clinically stable and >18 years old, were randomized to either a HIIT group or control group (standard care) for 1 year. The effect of training on CAV progression was assessed by intravascular ultrasound (IVUS).
  
  
  RESULTS
  IVUS analysis revealed a significantly smaller mean increase [95% CI] in atheroma volume (PAV) of 0.9% [95% CI -;0.3% to 1.9%] in the HIIT group as compared with the control group, 2.5% [1.6% to 3.5%] (p = 0.021). Similarly, the mean increase in total atheroma volume (TAV) was 0.3 [0.0 to 0.6] mm(3)/mm in the HIT group vs 1.1 [0.6 to 1.7] mm(3)/mm in the control group (p = 0.020), and mean increase in maximal intimal thickness (MIT) was 0.02-0.01 to 0.04] mm in the HIIT group vs 0.05 [0.03 to 0.08] mm in the control group (p = 0.054). Qualitative plaque progression (virtual histology parameters) and inflammatory activity (biomarkers) were similar between the 2 groups during the study period.
  
  
  CONCLUSIONS
  HIIT among maintenance HTx recipients resulted in a significantly impaired rate of CAV progression. Future larger studies should address whether exercise rehabilitation strategies should be included in CAV management protocols.
authors.affiliation: Department of Cardiology, Oslo University Hospital HF Rikshospitalet, Oslo. Electronic address: knytroen@ous-hf.no.
authors.forename: Kari
authors.initials: K
authors.lastname: Nytrøen
authors.forename: Lene Annette
authors.initials: LA
authors.lastname: Rustad
authors.forename: Ingrid
authors.initials: I
authors.lastname: Erikstad
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
authors.forename: Thor
authors.initials: T
authors.lastname: Ueland
authors.forename: Tove
authors.initials: T
authors.lastname: Lekva
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
authors.forename: Nils
authors.initials: N
authors.lastname: Wilhelmsen
authors.forename: Anders
authors.initials: A
authors.lastname: Hervold
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.forename: Satish
authors.initials: S
authors.lastname: Arora
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D018450:Disease Progression; D005081:Exercise Therapy / Q000145:classification*; D005260:Female; D016027:Heart Transplantation / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011446:Prospective Studies; D014180:Transplantation; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional
keywords: cardiac allograft vasculopathy; exercise; exercise capacity; heart transplant; high-intesity training; intravascular ultrasound; maximum oxygen uptake; rehabilitation