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European Heart Journal Advance Access originally published online on December 3, 2007
European Heart Journal 2008 29(1):139; doi:10.1093/eurheartj/ehm523
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Can prolonged exercise-induced myocardial ischaemia be innocuous?

Gabriele Fragasso

Heart Failure Clinic
Istituto Scientifico San Raffaele
Via Olgettina 60
20132 Milano
Italy

Tel: +39 02 26437395 Fax: +39 02 26437395Email: gabriele.fragasso{at}hsr.it

I read with interest the study by Nöel et al.1 aimed at evaluating the innocuousness of intense and prolonged exercise training above the threshold for myocardial ischaemia in patients with coronary artery disease. Following the training sessions, the authors evaluated cardiac troponin T and ventricular diameters and ejection fraction, which were found not significantly different from baseline (data are not reported). The authors conclude that ‘prolonged and repeated ischemic training sessions up to 60 min can be well tolerated without evidence of myocardial injury, significant arrhythmias or left ventricular dysfunction’. However, systolic function evaluation is not the most sensitive method to definitely exclude myocardial damage. Maximal exercise in patients with coronary disease has been shown to cause sustained diastolic dysfunction2 in the presence of unchanged systolic function. Considering that the evaluation of left ventricular response was the most important target of Nöel's study, the adoption of more accurate tests in order to objectively exclude progressive left ventricular deterioration in their patients would had been advisable. Among the others, evaluation of natriuretic peptides3 and diastolic function indexes determination by Doppler techniques4 or radionuclide ventriculography.5 Despite the study patients did not show significant changes in ejection fraction at follow-up, we cannot exclude that they had developed minor degrees of ventricular dysfunction. In fact, myocardial function and metabolism often remain abnormal for as a long as 1 week after short periods of ischaemia6 and brief repetitive bouts of ischaemia may have a cumulative effect and cause myocardial necrosis.7 Considering the context, I would prefer to see further studies before considering prolonged exercise-induced myocardial ischaemia as ‘innocuous’.

References

  1. Nöel M, Jobin J, Marcoux A, Poirier P, Dagenais GR, Bogaty P. Can prolonged exercise-induced myocardial ischaemia be innocuous? Eur Heart J (2007) 28:1559–1565.[Abstract/Free Full Text]
  2. Fragasso G, Benti R, Sciammarella M, Rossetti E, Savi A, Gerundini P, Chierchia S. Symptom-limited exercise testing causes sustained diastolic dysfunction in patients with coronary disease and low effort tolerance. J Am Coll Cardiol (1991) 17:1251–1255.[Abstract]
  3. Tschope C, Kasner M, Westermann D, Gaub R, Poller WC, Schultheiss HP. The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements. Eur Heart J (2005) 26:2277–2284.[Abstract/Free Full Text]
  4. Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, Marino P, Smiseth OA, De Keulenaer J, Leite-Moreira AF, Borbély A, Édes I, Handoko ML, Heymans S, Pezzali N, Pieske B, Dickstein K, Fraser AG, Brutsaert DL. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J (2007) Published online ahead of print April 11, 2007.
  5. Bonow RO, Bacharach SL, Green MV, Kent KM, Rosing DR, Lipson LC, Leon MB, Epstein SE. Impaired left ventricular diastolic filling in patients with coronary artery disease: assessment with radionuclide angiography. Circulation (1981) 64:315–323.[Abstract/Free Full Text]
  6. Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation (1982) 66:1146–1149.[Abstract/Free Full Text]
  7. Geft IL, Fishbein MC, Ninomiya K, Hashida J, Chaux E, Yano J, Y-Rit J, Genov T, Shell W, Ganz W. Intermittent brief periods of ischemia have a cumulative effect and may cause myocardial necrosis. Circulation (1982) 66:1150–1153.[Abstract/Free Full Text]

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/1/139    most recent
ehm523v1
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