Effects of Exercise Training on High-Mobility Group Box-1 Levels After Acute Myocardial Infarction

Background: High-mobility group box-1 (HMGB1) is a novel predictor of adverse postinfarction clinical outcomes, playing a crucial role in the appropriate postinfarction healing process. Methods and Results: Seventy-five postinfarction patients were enrolled in a single-center randomized study (clinicaltrial.gov identifier: NCT00755131). Group T patients (training, n = 37) underwent 6-month exercise-based cardiac rehabilitation (CR) program, whereas group C patients (controls, n = 38) were discharged with generic instructions for maintaining physical activity and a correct lifestyle. After 6 months, HMGB1 levels were significantly reduced in the total population (26.1 +/- 23.5 vs. 16.2 +/- 12.9 ng/mL; P = .0006). After adjusting for several confounders, linear regression analysis showed that the inclusion in the training group (beta = -10.54, P = .043) was associated with marked reduction of HMGB1 levels. After 6 months, HMGB1 levels were significantly lower in trained patients compared to controls (11.7 +/- 7.0 vs. 20.5 +/- 15.6 ng/mL, P = .0027, respectively). In trained patients, decreased HMGB1 levels were significantly associated with the improvement in peak oxygen consumption (beta = -3.879, P = .003) and heart rate recovery (beta = -2.492, P = .002), and with reduced left ventricular end-diastolic volume (beta = 1.412, P = .001) and wall motion score index (beta = 1.138, P = .002). Conclusions: The decrease in HMGB1 levels after anterior myocardial infarction was associated with exercise training and with the improvement of cardiopulmonary and autonomic function, and with favorable cardiac remodeling. (J Cardiac Fail 2011;17:108-114)