Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6308-6318
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6308
Effect of exercise training on left ventricular remodeling in patients with myocardial infarction and possible mechanisms
Meng Cai, Lei Wang, Yan-Long Ren
Meng Cai, Lei Wang, Department of Geriatrics, Beijing Jishuitan Hospital, Beijing 100000, China
Yan-Long Ren, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Author contributions: Wang L and Ren YL conceived of the study; Cai M, Wang L, and Ren YL participated in the study and collected the clinical data; Cai M and Wang L performed the statistical analysis and drafted the manuscript; Ren YL revised the manuscript; all authors read and approved the final manuscript.
Supported by Beijing Hospitals Authority Incubating Program, No. PZ2021007; Beijing Hospitals Authority Youth Program, No. QML20200604; and Beijing Municipal Health Commission (No. 17-3) and the Beijing Natural Science Foundation, No. 7184205.
Institutional review board statement: The authors declare that all experiments involving human subjects were designed and performed in compliance with the relevant laws regarding humane care and use of subjects.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to the manuscript.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Long Ren, MD, Professor, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing 100029, China. renyanlong@yeah.net
Received: April 8, 2021
Peer-review started: April 8, 2021
First decision: April 28, 2021
Revised: May 12, 2021
Accepted: June 7, 2021
Article in press: June 7, 2021
Published online: August 6, 2021
ARTICLE HIGHLIGHTS
Research background

A growing amount of evidence provides support for the hypothesis that acute myocardial infarction (AMI) patients should go through cardiopulmonary exercise testing about 3-5 d after AMI is diagnosed, make reasonable exercising prescription, and conduct exercise training under guidance.

Research motivation

To investigate the effect of exercise training on left ventricular systolic function and left ventricular remodeling and to study the possible mechanisms of left ventricular remodeling (LVRM) by the changes of matrix metallopeptidase 9 (MMP-9) and tissue inhibitor of metalloproteinases 1 (TIMP-1) in patients with acute ST-segment elevation myocardial infarction (STEMI).

Research objectives

To investigate the effect of exercise training on left ventricular systolic function and left ventricular remodeling and to study the possible mechanisms of LVRM.

Research methods

Sixty patients with first STEMI undergoing direct percutaneous coronary intervention from February 2008 to October 2008 were randomly assigned to an exercise group (n = 30) or a control group (n = 30). The levels of MMP-9 and TIMP-1 were measured in all patients at 1 d, 10-14 d, 30 d, and 6 mo after admission. Two-dimensional echocardiography and cardiopulmonary exercise testing were done in patients at 10-14 d and 6 mo after admission.

Research results

In cardiopulmonary exercise testing of the two group, at 6 mo, the time of exercise, peak and anaerobic threshold values of O2 uptake, and metabolic equivalents increased in both groups, but markedly increased in the exercise group than in the control group. There was no significant differences in LVESV, LVEDV, or left ventricular ejection fraction (LVEF) between the two groups. At 6 mo, LVEF increased in the exercise group, but not in the control group. Change in LVEF in the exercise group was significantly higher than that of the control group. At 6 mo, the percentage of patients with positive result of LVRM was 26.6% in the exercise group and 52.6% in the control group (P < 0.05). The levels of plasma MMP-9 and TIMP-1 and the ratio of MMP-9 to TIMP-1 in both groups had no significant difference at 1 d and 10-14 d after AMI, but at 30 d and 6 mo, the levels of plasma MMP-9 and TIMP-1 in the exercise group were significantly lower than those in the control group; the ratio of MMP-9 to TIMP-1 in the exercise group was significantly higher than that in the control group.

Research conclusions

Exercise training under supervision based on home condition in early and recovery stage of AMI can improve exercise cardiopulmonary function and prevent the LVRM. Therefore, it may reduce unfavorable remodeling response by decreasing the levels of plasma MMP-9 and TIMP-1 and adjusting the ratio of MMP-9 to TIMP-1 hereafter.

Research perspectives

Randomized controlled trials are needed to investigate the effect of exercise training on left ventricular systolic function and LVRM and to study the possible mechanisms of LVRM in patients with acute STEMI.