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European Heart Journal Advance Access originally published online on June 11, 2007
European Heart Journal 2007 28(13):1559-1565; doi:10.1093/eurheartj/ehm152
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Can prolonged exercise-induced myocardial ischaemia be innocuous?

Martin Noël, Jean Jobin, Audrey Marcoux, Paul Poirier, Gilles R. Dagenais and Peter Bogaty*

Quebec Heart Institute, Laval Hospital, Laval University, 2725 Chemin Ste-Foy, Ste-Foy, Quebec, Canada G1V 4G5

Received 30 October 2006; revised 1 April 2007; accepted 6 April 2007; online publish-ahead-of-print 11 June 2007.

* Corresponding author. Tel: +1 418 656 8711 ext. 5537; fax: +1 418 656 4685. E-mail address: peter.bogaty{at}med.ulaval.ca

See page 1543 for the editorial comment on this article (doi:10.1093/eurheartj/ehm187)

Aims: To evaluate the innocuousness of intense and prolonged exercise training above the threshold for myocardial ischaemia (1 mm ST-segment depression).

Methods and results: Twenty-two patients with ischaemic heart disease (IHD) were randomized to exercise training either at a target intensity that induced myocardial ischaemia (ischaemic group) or that adhered to current guidelines (control group). Training was progressively increased to 60 min under continuous electrocardiographic (ECG) monitoring. Cardiac troponin T (cTnT) was measured at various intervals. Ambulatory ECG monitoring was performed before and after 6 weeks of training and left ventricular function was evaluated in the ischaemic group after at least 6 weeks of training. The ischaemic group had myocardial ischaemia during the first 20, 40, and 60 min exercise sessions for 12.3 ± 6.8, 29.0 ± 12.9, and 49.8 ± 2.2 min, respectively, with ST-segment depression ranging from 1.0 to 2.1 mm. No patient in either group demonstrated significant arrhythmias or increased cTnT. The ischaemic group had preserved left ventricular function.

Conclusion: In patients with IHD, prolonged and repeated ischaemic training sessions up to 60 min can be well tolerated without evidence of myocardial injury, significant arrhythmias, or left ventricular dysfunction.

Key Words: Ischaemia • Exercise • Coronary disease • Electrocardiography • Training


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