Hayley T Dillon, Nicholas J Saner, Tegan Ilsley, David S Kliman, Stephen J Foulkes, Christian J Brakenridge, Andrew Spencer, Sharon Avery, Piet Claus, David W Dunstan, Robin M Daly, Steve F Fraser, Neville Owen, Brigid M Lynch, Bronwyn A Kingwell, Andre La Gerche, Erin J Howden
{"title":"预防同种异体干细胞移植导致的心血管功能障碍：ALLO-Active 试验。","authors":"Hayley T Dillon, Nicholas J Saner, Tegan Ilsley, David S Kliman, Stephen J Foulkes, Christian J Brakenridge, Andrew Spencer, Sharon Avery, Piet Claus, David W Dunstan, Robin M Daly, Steve F Fraser, Neville Owen, Brigid M Lynch, Bronwyn A Kingwell, Andre La Gerche, Erin J Howden","doi":"10.1161/CIRCULATIONAHA.124.070709","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.</p><p><strong>Methods: </strong>Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (n=30) or usual care (UC; n=32). Activity comprised multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CI<sub>peak</sub>) and stroke volume (SVI<sub>peak</sub>) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]).</p><p><strong>Results: </strong>Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg<sup>-1</sup>‧min<sup>-1</sup> [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg<sup>-1‧</sup>min<sup>-1</sup> [95% CI, -2.5 to 0.8]; interaction <i>P</i>=0.029). Activity preserved exercise cardiac function, with preservation of CI<sub>peak</sub> (0.30 L‧min<sup>-1</sup>‧m<sup>-</sup><sup>2</sup> [95% CI, -0.34 to 0.41]) and SVI<sub>peak</sub> (0.6 mL/m<sup>2</sup> [95% CI, -1.3 to 2.5]), both of which declined with UC (CI<sub>peak</sub>, -0.68 L‧min<sup>-1</sup>‧m<sup>-</sup><sup>2</sup> [95% CI, -1.3 to -0.32]; interaction <i>P</i>=0.008; SVI<sub>peak</sub>, -2.7 mL/m<sup>2</sup> [95% CI, -4.6 to -0.9]; interaction <i>P=</i>0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices.</p><p><strong>Conclusions: </strong>Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT.</p><p><strong>Registration: </strong>URL: https://anzctr.org.au/; Unique identifier: ACTRN12619000741189.</p>","PeriodicalId":35,"journal":{"name":"Energy & Fuels","volume":null,"pages":null},"PeriodicalIF":5.2000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preventing Allogeneic Stem Cell Transplant-Related Cardiovascular Dysfunction: ALLO-Active Trial.\",\"authors\":\"Hayley T Dillon, Nicholas J Saner, Tegan Ilsley, David S Kliman, Stephen J Foulkes, Christian J Brakenridge, Andrew Spencer, Sharon Avery, Piet Claus, David W Dunstan, Robin M Daly, Steve F Fraser, Neville Owen, Brigid M Lynch, Bronwyn A Kingwell, Andre La Gerche, Erin J Howden\",\"doi\":\"10.1161/CIRCULATIONAHA.124.070709\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.</p><p><strong>Methods: </strong>Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (n=30) or usual care (UC; n=32). Activity comprised multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CI<sub>peak</sub>) and stroke volume (SVI<sub>peak</sub>) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]).</p><p><strong>Results: </strong>Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg<sup>-1</sup>‧min<sup>-1</sup> [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg<sup>-1‧</sup>min<sup>-1</sup> [95% CI, -2.5 to 0.8]; interaction <i>P</i>=0.029). Activity preserved exercise cardiac function, with preservation of CI<sub>peak</sub> (0.30 L‧min<sup>-1</sup>‧m<sup>-</sup><sup>2</sup> [95% CI, -0.34 to 0.41]) and SVI<sub>peak</sub> (0.6 mL/m<sup>2</sup> [95% CI, -1.3 to 2.5]), both of which declined with UC (CI<sub>peak</sub>, -0.68 L‧min<sup>-1</sup>‧m<sup>-</sup><sup>2</sup> [95% CI, -1.3 to -0.32]; interaction <i>P</i>=0.008; SVI<sub>peak</sub>, -2.7 mL/m<sup>2</sup> [95% CI, -4.6 to -0.9]; interaction <i>P=</i>0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices.</p><p><strong>Conclusions: </strong>Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT.</p><p><strong>Registration: </strong>URL: https://anzctr.org.au/; Unique identifier: ACTRN12619000741189.</p>\",\"PeriodicalId\":35,\"journal\":{\"name\":\"Energy & Fuels\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.2000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Energy & Fuels\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCULATIONAHA.124.070709\",\"RegionNum\":3,\"RegionCategory\":\"工程技术\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ENERGY & FUELS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Energy & Fuels","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCULATIONAHA.124.070709","RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENERGY & FUELS","Score":null,"Total":0}
Background: Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.
Methods: Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (n=30) or usual care (UC; n=32). Activity comprised multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CIpeak) and stroke volume (SVIpeak) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]).
Results: Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg-1‧min-1 [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg-1‧min-1 [95% CI, -2.5 to 0.8]; interaction P=0.029). Activity preserved exercise cardiac function, with preservation of CIpeak (0.30 L‧min-1‧m-2 [95% CI, -0.34 to 0.41]) and SVIpeak (0.6 mL/m2 [95% CI, -1.3 to 2.5]), both of which declined with UC (CIpeak, -0.68 L‧min-1‧m-2 [95% CI, -1.3 to -0.32]; interaction P=0.008; SVIpeak, -2.7 mL/m2 [95% CI, -4.6 to -0.9]; interaction P=0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices.
Conclusions: Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT.
期刊介绍：
Energy & Fuels publishes reports of research in the technical area defined by the intersection of the disciplines of chemistry and chemical engineering and the application domain of non-nuclear energy and fuels. This includes research directed at the formation of, exploration for, and production of fossil fuels and biomass; the properties and structure or molecular composition of both raw fuels and refined products; the chemistry involved in the processing and utilization of fuels; fuel cells and their applications; and the analytical and instrumental techniques used in investigations of the foregoing areas.
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