Impact of Intensive Exercise Training on Coronary Collateral Circulation in Patients With Stable CAD - EXCITE

Description:

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.

Study Design

  • Randomized
  • Parallel

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%

Inclusion criteria:

  • Patients 19-75 years of age with symptoms of stable ischemic heart disease

Exclusion criteria:

  • 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

Principal Findings:

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.

Secondary outcomes:

  • 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

Interpretation:

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.

References:

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.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise

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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