Interval training does not modulate diastolic function in heart transplant recipients

Figures & data

Table I. Validation study: Inter-analyser variability and measurements of repeatability by the method of Bland Altman.

	Mean difference	Limits of agreement	Coefficient of variation (%)
E-rest (m/s)	10.0	± 12.7	8.2
E-50 watt (m/s)	8.3	± 12.3	5.9
E-recovery (m/s)	12.3	± 15.5	8.9
A-rest (m/s)	9.0	± 19.0	20.4
A-50 watt (m/s)	10.9	± 34.1	25.8
A–recovery (m/s)	3.2	± 19.0	16.5
e′-rest (cm/s)	1.1	± 2.4	7.3
e′-50 watt (cm/s)	0.6	± 3.7	9.6
e′-recovery (cm/s)	1.2	± 1.4	4.1

E, early inflow; A, atrial inflow; e′, mitral annulus velocity.

Figure 1. Flowchart over inclusion and exclusion.

Table II. Baseline patient characteristics.

	All (n = 23)	Training	Control	p-value
Male n (%)	18 (78%)	11 (85%)	7 (70%)	0.71
Age (years)	50 (± 15)	52 (± 11)	47 (± 19)	0.42
Time since transplantation (years)	7.0 (± 5)	7.0 (± 4)	8.0 (± 6)	0.60
Systolic blood pressure (mmHg)	143 (± 14)	143 (± 17)	142 (± 10)	0.92
Diastolic blood pressure (mmHg)	84 (± 8)	85 (± 8)	83 (± 10)	0.74
Resting heart rate (s^− 1)	77 (± 7)	73 (± 4)	78 (± 6)	0.09
Body mass index (kg/m^2)	25.7 (± 4.4)	26.5 (± 3.4)	24.7 (± 5.4)	0.34
Diabetes (%/n)	17/4	23/3	10/1	0.67
Medication
Prednisolone (%/n)	100/23	100/13	100/10	0.24
Tacrolimus (%/n)	17/4	15/2	20/2	0.76
Cyclosporin (%/n)	78/18	85/11	70/7	0.15
Exercise testing
Max. heart rate (s^− 1)	141 (± 20)	141 (± 18)	141 (± 22)	0.97
VO2peak (ml/kg/min)	24.2 (± 6.0)	23.9 (± 7.0)	24.6 (± 4.5)	0.77
Echocardiographic parameters
LV Ejection Fraction (%)	60 (± 10)	63 (± 6)	58 (± 14)	0.25
Left atrial size (ml)	89 (± 41)	85 (± 34)	90 (± 51)	0.77
LV mass/bsa (g/m^2)	88 (± 29)	76 (± 26)	106 (± 23)	0.01
E (ms)	89 (± 23)	84 (± 25)	95 (± 18)	0.26
A (ms)	43 (± 10)	42 (± 12)	44 (± 8)	0.54
E/A	2.1 (± 0.6)	2.1 (± 0.6)	2.2 (± 0.6)	0.65
E/e′	8.9 (± 2.8)	8.2 (± 2.9)	9.9 (± 2.3)	0.14
Dec.time(ms)	187 (± 54)	176 (± 56)	200 (50)	0.95
s′ (cm/s)	8.4 (± 2.0)	9.3 (± 1.6)	7.2 (± 1.8)	0.008

Values are mean (± SD) and number (%). P-value for difference between groups.

Figure 2. Echocardiographic parameters during exercise echocardiography, at rest, at 30%, 60% of maximum workload and in recovery. Thick lines are training group, thin lines control group. Continuous lines values before training, dotted lines values after training. Vertical lines are S.E of the mean. P-values refer to the results of likelihood test of multi-level models.

Table III. Effect of training on hemodynamic parameters and body mass index.

	Training group (n = 13)		Control group (n = 10)		P-value*
	Before	After	Before	After
Systolic BP (mmHg)	143 (± 18)	127 (± 13)	142 (± 10)	144 (± 24)	0.026
Diastolic BP (mmHg)	85 (± 8)	82 (± 10)	83 (± 10)	84 (± 15)	0.189
BMI (kg/m^2)	26.5 (± 3.4)	26.2 (± 3.2)	24.7 (± 5.4)	24.7 (± 5.5)	0.075
Resting HR (s^− 1)	73 (± 4)	75 (± 8)	78 (± 6)	80 (± 12)	0.496
Max HR (s^− 1)	149 (± 8)	144 (± 16)	141 (± 22)	136 (± 20)	0.124
Max workload (watt)	161 (± 54)	185 (± 53)	146 (± 31)	148 (± 27)	0.005
VO2peak (ml/kg/min)	23.9 (± 7.0)	28.3 (± 6.4)	24.6 (± 4.5)	24.0 (± 5.5)	0.002

BP, Blood pressure; HR, heart rate; BMI, Body mass index.

*P-value for comparison of within-group changes.

Table IV. Echocardiographic parameters before and after training.

	Intervention (n = 13)		Control (n = 10)
	Before	After	Before	After
E/e′
Rest	8.2 (± 2.9)	7.5 (± 2.0)	9.9 (± 2.3)	10.4 (± 3.3)
30%	10.5 (± 2.7)	9.8 (± 4.1)	13.8 (± 5.8)	16.9 (± 9.0)
60%	10.9 (± 4.1)	10.8 (± 4.1)	15.4 (± 0.8)	12.3 (± 3.0)
Recovery	9.6 (± 2.6)	9.9 (± 3.5)	12.5 (± 2.5)	12.1 (± 3.3)
E/A
Rest	2.1 (± 0.56)	2.1 (± 0.7)	2.2 (± 0.56)	2.6 (± 1.1)
30%	2.4 (± 0.7)	2.2 (± 0.4)♣	2.7 (± 0.8)	2.9 (± 0.5)♣
60%	2.2 (± 0.3)♣	2.0 (± 0.5)♣	3.0 (± 0.8)♣	2.7 (± 0.4)♣
Recovery	1.9 (± 0.7)	2.0 (± 0.7)	4.9 (± 0.7)	2.4 (± 0.4)
Dec.time (ms)
Rest	176.2 (± 55.9)	216 (± 61.4)	200.0 (± 50.3)	193 (± 32)
30%	123.8 (± 30.1)	151.5 (± 38.5)	150 (± 34.3)	135 (± 26.4)
60%	111.9 (± 21.8)	133.8 (± 16.11)	125. (± 30.2)	134.4 (± 18.1)
Recovery	148.5 (± 33.4)	155 (± 32.1)	177.5 (± 45.3)	170.5 (± 40.5)
S′ (cm7s)
Rest	9.3 (± 1.6)♣	7.7 (± 2.8)	7.2 (± 1.8)♣	8.4 (± 1.7)
30%	9.7 (± 1.5)♣	8.9 (± 1.2)	7.8 (± 1.5)♣	8.8 (± 1.6)
60%	11.5 (± 2.0)♣	9.6 (± 1.9)	8.8 (± 2.0)♣	10.7 (± 2.0)
Recovery	12.5 (± 2.1)♣	9.3 (± 1.6)	8.4 (± 2.5)♣	10.4 (± 1.6)

♣Indicates p-value below 0.05 for within group comparison by paired t-test.