Physical Activity, Subclinical Myocardial Injury, and Risk of Heart Failure Subtypes in Black Adults

Patel, Kershaw V.; Simek, Shawn; Ayers, Colby; Neeland, Ian J.; deFilippi, Christopher R.; Seliger, Stephen L.; Lonergan, Katy; Minniefield, Nicole; Mentz, Robert J.; Correa, Adolfo; Yimer, Wondwosen K.; Hall, Michael E.; Rodríguez, Carlos J.; Lemos, James A. de; Berry, Jarett D.; Pandey, Ambarish

doi:10.1016/j.jchf.2021.04.003

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…These findings support the hypothesis that even a small reduction in hs‐cTnI may have prognostic clinical significance. These findings are consistent with the results in a recent study in black adults with subclinical myocardial injury, in which higher levels of physical activity were associated with reduced risk of heart failure with preserved ejection fraction (HFpEF) 21 . Subclinical myocardial injury were defined as hs‐cTnI >6 ng/L, a level considerably lower than in our population.…”

Section: Discussionsupporting

confidence: 92%

Exercise training and high‐sensitivity cardiac troponin‐I in patients with heart failure with reduced ejection fraction

Riveland,

Valborgland,

Ushakova

et al. 2024

ESC Heart Failure

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AimsThe aims of this sub‐study of the SMARTEX trial were (1) to evaluate the effects of a 12‐week exercise training programme on serum levels of high sensitivity cardiac troponin I (hs‐cTnI) in patients with moderate chronic heart failure (CHF), in New York Heart Association class II‐III with reduced ejection fraction (HFrEF) and (2) to explore the associations with left ventricular remodelling, functional capacity and filling pressures measured with N‐terminal pro brain natriuretic peptide (NT‐proBNP).Methods and resultsIn this sub‐study, 196 patients were randomly assigned to high intensity interval training (HIIT, n = 70), moderate continuous training (MCT, n = 59) or recommendation of regular exercise (RRE), (n = 67) for 12 weeks. To reveal potential difference between structured intervention and control, HIIT and MCT groups were merged and named supervised exercise training (SET) group. The RRE group constituted the control group (CG). To avoid contributing factors to myocardial injury, we also evaluated changes in patients without additional co‐morbidities (atrial fibrillation, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease). The relationship between hs‐cTnI and left ventricular end‐diastolic diameter (LVEDD), VO2peak, and NT‐proBNP was analysed by linear mixed models. At 12 weeks, Hs‐cTnI levels were modestly but significantly reduced in the SET group from median 11.9 ng/L (interquartile ratio, IQR 7.1–21.8) to 11.5 ng/L (IQR 7.0–20.7), P = 0.030. There was no between‐group difference (SET vs. CG, P = 0.116). There was a numerical but not significant reduction in hs‐cTnI for the whole population (P = 0.067) after 12 weeks. For the sub‐group of patients without additional co‐morbidities, there was a significant between‐group difference: SET group (delta −1.2 ng/L, IQR −2.7 to 0.1) versus CG (delta −0.1 ng/L, IQR −0.4 to 0.7), P = 0.007. In the SET group, hs‐cTnI changed from 10.9 ng/L (IQR 6.0–22.7) to 9.2 ng/L (IQR 5.2–20.5) (P = 0.002), whereas there was no change in the CG (6.4 to 5.8 ng/L, P = 0.64). Changes in hs‐cTnI (all patients) were significantly associated with changes in; LVEDD, VO2peak, and NT‐proBNP, respectively.ConclusionsIn patients with stable HFrEF, 12 weeks of structured exercise intervention was associated with a modest, but significant reduction of hs‐cTnI. There was no significant difference between intervention group and control group. In the sub‐group of patients without additional co‐morbidities, this difference was highly significant. The alterations in hs‐cTnI were associated with reduction of LVEDD and natriuretic peptide concentrations as well as improved functional capacity.

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Section: Discussionsupporting

confidence: 92%

Exercise training and high‐sensitivity cardiac troponin‐I in patients with heart failure with reduced ejection fraction

Riveland,

Valborgland,

Ushakova

et al. 2024

ESC Heart Failure

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“…Higher levels of physical activity are associated with lower risk of HF on follow-up, particularly related to risk of HFpEF [45]. Similar findings have been observed in a separate cohort suggesting physical activity may be more closely related to risk of HFpEF compared with HFrEF [46].…”

Section: Lifestyle Modification-obesity and Physical Inactivitysupporting

confidence: 76%

Team-based strategies to prevent heart failure

Taha

Patel

Nasir

2022

Current Opinion in Cardiology

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Purpose of reviewThe burden of heart failure (HF) in the United States and worldwide is projected to rise. Prevention of HF can curb the burden of this chronic syndrome, but current approaches are limited. This review discusses team-based strategies aimed to prevent HF.Recent findingsIndividuals at high risk for developing HF can be identified using HF risk scores, biomarkers, and cardiac imaging. Electronic medical records (EMR) can integrate clinical data to estimate HF risk and identify individuals who may benefit most from preventive therapies. Team-based interventions can lead to enhanced adherence to medications, optimization of medical management, and control of risk factors. Multifaceted interventions involve EMR-based strategies, pharmacist- and nurse-led initiatives, involvement of community personnel, polypills, and digital solutions.SummaryTeam-based strategies aimed to prevent HF incorporate a broad group of personnel and tools. Despite implementation challenges, existing resources can be efficiently utilized to facilitate team-based approaches to potentially reduce the burden of HF.

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“…Notably, our study determined that hs-cTnI was one of the factors associated with clinical outcomes. Lokaj et al ( 20 ) demonstrated that hs-cTnI levels ≥17 ng/L represented an increased risk of poor prognosis in patients with HF, and elevated hs-cTnI was a risk factor for HFpEF in Black adults; however, the specific mechanism remains unclear ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on the clinical significance of cardiac computed tomography in heart failure patients with preserved ejection fraction

Xin¹,

Zhang²,

Liu³

et al. 2022

Ann Transl Med

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Physical Activity, Subclinical Myocardial Injury, and Risk of Heart Failure Subtypes in Black Adults

Cited by 13 publications

References 23 publications

Exercise training and high‐sensitivity cardiac troponin‐I in patients with heart failure with reduced ejection fraction

Exercise training and high‐sensitivity cardiac troponin‐I in patients with heart failure with reduced ejection fraction

Team-based strategies to prevent heart failure

A retrospective study on the clinical significance of cardiac computed tomography in heart failure patients with preserved ejection fraction

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