TY - JOUR
T1 - Exercise training improves cardiovascular fitness in dilated cardiomyopathy caused by truncating titin variants
AU - Flensted, Ida Finsen
AU - Stemmerik, Mads Godtfeldt
AU - Skriver, Sofie Vinther
AU - Axelsen, Kasper Holst
AU - Christensen, Alex Hørby
AU - Lundby, Carsten
AU - Bundgaard, Henning
AU - Vissing, John
AU - Vissing, Christoffer Rasmus
N1 - © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/11/25
Y1 - 2024/11/25
N2 - BACKGROUND: Participation in regular exercise activities is recommended for patients with chronic heart failure. However, less is known about the effect of exercise in patients with genetic dilated cardiomyopathy (DCM). We sought to examine the effect of vigorousintensity training on physical capacity in patients with DCM caused by truncating titin variants (TTNtv).TRIAL DESIGN: Non-randomised clinical pre-post trial of exercise training.METHODS: Individuals with DCM-TTNtv were included from outpatient clinics for inherited cardiac diseases. The trial consisted of 8 weeks of usual care followed by 8 weeks of regular vigorous-intensity cycling exercise, enclosed by three test days. The primary outcome was change in peak oxygen uptake (VO2). Secondary outcomes included change in blood volume, total haemoglobin mass, measures of systolic function and cardiac output/stroke volume during exercise.RESULTS: Thirteen out of 14 included participants (43% women, age 48±11 years, body mass index: 30±6 kg/m2) completed the trial. In the exercise training period, peak VO2 increased by +1.9 mL/kg/min (95% CI +0.9 to +2.9, p=0.002). Compared with usual care, exercise training improved peak VO2 by +2.9 mL/kg/min (95% CI +1.2 to +4.5, p=0.002), corresponding to a 10% increase. Adaptations to exercise training included an increase in resting cardiac output (+0.8 L/min, p=0.042), total blood volume (+713 mL, p<0.001), total haemoglobin mass (+73 g, p<0.001), and improved left ventricular (LV) systolic function (LV ejection fraction: +3.2% (p=0.053) and global longitudinal strain: -2.0% (p=0.044)). No exercise-related adverse events or change in plasma biomarkers of cardiac or skeletal muscle damage were observed.CONCLUSIONS: Our study shows that vigorous intensity exercise training improved peak VO2 in patients with DCM-TTNtv. Exercise training was associated with improved LV systolic function and increased blood volume and oxygen carrying capacity. Future research should investigate the effect of long-term exercise in this group.TRIAL REGISTRATION NUMBER: NCT05180188.
AB - BACKGROUND: Participation in regular exercise activities is recommended for patients with chronic heart failure. However, less is known about the effect of exercise in patients with genetic dilated cardiomyopathy (DCM). We sought to examine the effect of vigorousintensity training on physical capacity in patients with DCM caused by truncating titin variants (TTNtv).TRIAL DESIGN: Non-randomised clinical pre-post trial of exercise training.METHODS: Individuals with DCM-TTNtv were included from outpatient clinics for inherited cardiac diseases. The trial consisted of 8 weeks of usual care followed by 8 weeks of regular vigorous-intensity cycling exercise, enclosed by three test days. The primary outcome was change in peak oxygen uptake (VO2). Secondary outcomes included change in blood volume, total haemoglobin mass, measures of systolic function and cardiac output/stroke volume during exercise.RESULTS: Thirteen out of 14 included participants (43% women, age 48±11 years, body mass index: 30±6 kg/m2) completed the trial. In the exercise training period, peak VO2 increased by +1.9 mL/kg/min (95% CI +0.9 to +2.9, p=0.002). Compared with usual care, exercise training improved peak VO2 by +2.9 mL/kg/min (95% CI +1.2 to +4.5, p=0.002), corresponding to a 10% increase. Adaptations to exercise training included an increase in resting cardiac output (+0.8 L/min, p=0.042), total blood volume (+713 mL, p<0.001), total haemoglobin mass (+73 g, p<0.001), and improved left ventricular (LV) systolic function (LV ejection fraction: +3.2% (p=0.053) and global longitudinal strain: -2.0% (p=0.044)). No exercise-related adverse events or change in plasma biomarkers of cardiac or skeletal muscle damage were observed.CONCLUSIONS: Our study shows that vigorous intensity exercise training improved peak VO2 in patients with DCM-TTNtv. Exercise training was associated with improved LV systolic function and increased blood volume and oxygen carrying capacity. Future research should investigate the effect of long-term exercise in this group.TRIAL REGISTRATION NUMBER: NCT05180188.
KW - Cardiac Rehabilitation
KW - Cardiomyopathy
KW - Dilated
KW - Heart Failure
KW - Cardiorespiratory Fitness
KW - Exercise Tolerance/physiology
KW - Ventricular Function, Left/physiology
KW - Humans
KW - Middle Aged
KW - Oxygen Consumption
KW - Male
KW - Stroke Volume/physiology
KW - Treatment Outcome
KW - Connectin/genetics
KW - Adult
KW - Female
KW - Exercise Therapy/methods
KW - Cardiomyopathy, Dilated/physiopathology
UR - http://www.scopus.com/inward/record.url?scp=85205575044&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2024-323995
DO - 10.1136/heartjnl-2024-323995
M3 - Journal article
C2 - 39317439
SN - 1355-6037
VL - 110
SP - 1416
EP - 1425
JO - Heart (British Cardiac Society)
JF - Heart (British Cardiac Society)
IS - 24
M1 - heartjnl-2024-323995
ER -