Impact of Intensive Exercise Training on Coronary Collateral Circulation in Patients With Stable CAD - EXCITE
The goal of the trial was to evaluate the impact of intense versus moderate exercise on coronary collateral circulation.
Contribution to the Literature: The EXCITE trial showed that both moderate and intense exercise were effective at improving coronary collateral circulation.
Patients with stable ischemic heart disease and fractional flow reserve (FFR) ≤0.75 were randomized to intense exercise (n = 20) versus moderate exercise (n = 20) versus control (n = 20).
The coronary collateral flow index (CFI) was assessed at 4 weeks by catheterization during which time a pressure wire was placed across the stenosis and hemodynamics were recorded during balloon occlusion to stop antegrade flow.
- Total number of enrollees: 60
- Duration of follow-up: 4 weeks
- Mean patient age: 64 years
- Percentage female: 25%
- Percentage diabetics: 53%
- Patients 19-75 years of age with symptoms of stable ischemic heart disease
- Contraindications to adenosine
- Unstable angina or acute myocardial infarction within last 2 months
- Significant valvular heart disease
- Significant peripheral arterial disease
- Significant left main disease
- Ostial coronary lesions
- Congestive heart failure with left ventricular ejection fraction <40%
- Life expectancy <1 year
The primary outcome, change in coronary CFI at 4 weeks, was 0.06 in the intense exercise group (p = 0.001 vs. control) versus 0.06 in the moderate exercise group (p = 0.001 vs. control) versus 0.001 in the control group. There was no difference between intense exercise versus moderate exercise.
- Change in peak VO2 at 4 weeks: 3.10 ml/kg/min in the intense exercise group versus 3.88 ml/kg/min in the moderate exercise group versus 0.46 ml/kg/min in the control group
- Change in physical capacity at 4 weeks: 19 watts in the intense exercise group versus 20 watts in the moderate exercise group versus 5.0 watts in the control group
- Change in Canadian Cardiovascular Society Angina Grading Scale at 4 weeks: –0.40 the intense exercise group versus –0.85 in the moderate exercise group versus –0.05 in the control group
Among patients with stable ischemic heart disease and documented ischemia by FFR, both moderate and intense exercise were effective at improving the coronary CFI at 4 weeks. Exercise also improved peak VO2, physical capacity, and angina severity compared with the control group.
Möbius-Winkler S, Uhlemann M, Adams V, et al. Coronary collateral growth induced by physical exercise: Results of the Impact of Intensive Exercise Training on Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease (EXCITE) Trial. Circulation 2016;233:1438-48.
Keywords: Angina Pectoris, Balloon Occlusion, Catheterization, Collateral Circulation, Constriction, Pathologic, Coronary Circulation, Coronary Artery Disease, Exercise, Fractional Flow Reserve, Myocardial, Hemodynamics, Myocardial Ischemia, Secondary Prevention
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