Effects of Cardiac Rehabilitation on High Mobility Group Box-1 Levels After Acute Myocardial Infarction
Condition: Acute Myocardial Infarction
MeSH terms: Myocardial Infarction; Infarction
Study type: Interventional

Summary: 
      This purpose of this study is to examine the relationship between HMGB-1 and postinfarction
      predictors of outcome such as cardiopulmonary and echocardiographic parameters before and
      after a 6-month exercise-based cardiac rehabilitation program.
    

Detailed description: 
      Exercise-based Cardiac Rehabilitation after acute myocardial infarction (AMI) has beneficial
      effects on cardiovascular functional capacity, quality of life, risk factors modification,
      and morbidity and mortality. Mounting evidences suggest that inflammation plays a key role
      both on initiation and progression of atherosclerosis. Several markers of systemic
      inflammation appear to be active effectors in the pathophysiology of athero-thrombotic
      disease leading to the occurrence of AMI.

      The high mobility group box 1 (HMGB-1) is a ubiquitous nuclear protein constitutively
      expressed in quiescent cells, and it has been implicated in several cellular functions,
      including determination of nucleosomal structure and stability, and binding of transcription
      factors to DNA sequences. HMGB-1 has been recently recognized as a critical mediator of
      inflammatory diseases. In fact, the passive release of this protein from necrotic or damaged
      cells represents an effective stimulus triggering the inflammatory response. Specifically,
      HMGB-1 binds to the receptor for advanced glycation end products (RAGE) and, in turns, it
      activates mitogen-activated protein-kinase (MAPK) and nuclear factor-κB (NF-κB).

      This intracellular pathway leads to the production of several pro-inflammatory cytokines.
      Interestingly, increased levels of HMGB-1 have been observed in atherosclerotic lesions,
      suggesting that HMGB-1 might be involved in the pathophysiology of atherosclerosis.

      This study was designed to investigate the relationship between HMGB-1 and strong
      postinfarction predictors of outcome such as cardiopulmonary and echocardiographic parameters
      before and after a 6-month exercise-based Cardiac Rehabilitation program.
    

Intervention name(s): Exercise-based Cardiac Rehabilitation program
Intervention type(s): Other
Intervention description(s): Trained patients attend the exercise training protocol for 6 months on hospital ambulatory-based regimen 3 times/week. Training sessions are supervised under continuous electrocardiography monitoring by a cardiologist, a physiotherapist and a graduate nurse. Each session is preceded by a 5-min warming-up and followed by a 5-min cooling-down. Exercise is performed for 30 min on a bicycle ergometer with the target of 60-70% of the peak oxygen consumption achieved at the initial symptom-limited cardiopulmonary exercise test. Exercise protocol is performed with a gradual increase in exercise workload until the achievement of the predefined target.
Other intervention name(s): Cardiac Rehabilitation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Basic Science
Keywords: Cardiac Rehabilitation; High Mobility Group Box proteins; Inflammatory markers; Cardiopulmonary Functional Capacity; Maximal Oxygen Consumption; Echocardiography; Left Ventricular Ejection Fraction; Left Ventricular Chambers Dilation; Left Ventricular Remodeling; Left Atrium Remodeling; Cardiac Remodeling; Exercise Training