(Circulation. 1996;93:210-214.)
© 1996 American Heart Association, Inc.
Articles |
Physical Training Improves Endothelial Function in Patients With Chronic Heart Failure
From the Med Klinik III, University of Freiburg (Germany).
Correspondence to Helmut Drexler, MD, Med Klinik III, University of Freiburg, Hugstetterstr 55, 79106 Freiburg, Germany.
Background Chronic heart failure is associated with endothelial dysfunction including impaired endothelium-mediated, flow-dependent dilation (FDD). Since endothelial function is thought to play an important role in coordinating tissue perfusion and modulating arterial compliance, interventions to improve endothelial dysfunction are imperative.
Methods and Results To assess the potential of physical training to restore FDD, 12 patients with chronic heart failure were studied and compared with FDD of 7 age-matched normal subjects. With a recently developed high-resolution ultrasound system, diameters of radial artery were measured at rest, during reactive hyperemia (with increased flow causing endothelium-mediated dilation), and during sodium nitroprusside, causing endothelium-independent dilation. Determination of FDD was repeated after intra-arterial infusion of NG-monomethyl-L-arginine (L-NMMA, 7 µmol/min) to inhibit endothelial synthesis and release of nitric oxide. The protocol was performed at baseline, after 4 weeks of daily handgrip training, and 6 weeks after cessation of the training program. FDD was impaired in heart failure patients compared with normal subjects. L-NMMA attenuated FDD, indicating that the endothelial release of nitric oxide is involved in FDD. Physical training restored FDD in patients with heart failure. In particular, the portion of FDD inhibited by L-NMMA (representing FDD mediated by nitric oxide) was significantly higher after physical training (8-minute occlusion: 8.0±1% versus 5.4±0.9%; P<.05; normal subjects: 9.2±1%).
Conclusions These results indicate that physical training restores FDD in patients with chronic heart failure, possibly by enhanced endothelial release of nitric oxide.
Key Words: heart failure • endothelium • exercise • endothelium-derived factor
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Y. Ishibashi, T. Shimada, T. Sakane, N. Takahashi, T. Sugamori, S. Ohhata, S.-i. Inoue, H. Katoh, K. Sano, Y. Murakami, et al. Contribution of endogenous nitric oxide to basal vasomotor tone of peripheral vessels and plasma B-Type natriuretic peptide levels in patients with congestive heart failure J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1605 - 1611. [Abstract] [Full Text] [PDF]
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A. Maiorana, G. O'Driscoll, L. Dembo, C. Cheetham, C. Goodman, R. Taylor, and D. Green Effect of aerobic and resistance exercise training on vascular function in heart failure Am J Physiol Heart Circ Physiol, October 1, 2000; 279(4): H1999 - H2005. [Abstract] [Full Text] [PDF]
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R. Varin, P. Mulder, F. Tamion, V. Richard, J.-P. Henry, F. Lallemand, G. Lerebours, and C. Thuillez Improvement of Endothelial Function by Chronic Angiotensin-Converting Enzyme Inhibition in Heart Failure : Role of Nitric Oxide, Prostanoids, Oxidant Stress, and Bradykinin Circulation, July 18, 2000; 102(3): 351 - 356. [Abstract] [Full Text] [PDF]
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S. Taddei, F. Galetta, A. Virdis, L. Ghiadoni, G. Salvetti, F. Franzoni, C. Giusti, and A. Salvetti Physical Activity Prevents Age-Related Impairment in Nitric Oxide Availability in Elderly Athletes Circulation, June 27, 2000; 101(25): 2896 - 2901. [Abstract] [Full Text] [PDF]
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 R. Hambrecht, S. Gielen, A. Linke, E. Fiehn, J. Yu, C. Walther, N. Schoene, and G. Schuler Effects of Exercise Training on Left Ventricular Function and Peripheral Resistance in Patients With Chronic Heart Failure: A Randomized Trial JAMA, June 21, 2000; 283(23): 3095 - 3101. [Abstract] [Full Text] [PDF]
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U. Landmesser, R. Merten, S. Spiekermann, K. Buttner, H. Drexler, and B. Hornig Vascular Extracellular Superoxide Dismutase Activity in Patients With Coronary Artery Disease : Relation to Endothelium-Dependent Vasodilation Circulation, May 16, 2000; 101(19): 2264 - 2270. [Abstract] [Full Text] [PDF]
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R. Hambrecht, L. Hilbrich, S. Erbs, S. Gielen, E. Fiehn, N. Schoene, and G. Schuler Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation J. Am. Coll. Cardiol., March 1, 2000; 35(3): 706 - 713. [Abstract] [Full Text] [PDF]
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A. Lavrencic, B. G. Salobir, and I. Keber Physical Training Improves Flow-Mediated Dilation in Patients With the Polymetabolic Syndrome Arterioscler Thromb Vasc Biol, February 1, 2000; 20(2): 551 - 555. [Abstract] [Full Text] [PDF]
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K. J. Osterziel, S. M Bode-Boger, O. Strohm, A. E Ellmer, N. Bit-Avragim, D. Hanlein, M. B Ranke, R. Dietz, and R. H Boger Role of nitric oxide in the vasodilator effect of recombinant human growth hormone in patients with dilated cardiomyopathy Cardiovasc Res, January 14, 2000; 45(2): 447 - 453. [Abstract] [Full Text] [PDF]
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D. P. Thomas and O. Hudlicka Arteriolar reactivity and capillarization in chronically stimulated rat limb skeletal muscle post-MI J Appl Physiol, December 1, 1999; 87(6): 2259 - 2265. [Abstract] [Full Text] [PDF]
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H. Drexler Nitric oxide and coronary endothelial dysfunction in humans Cardiovasc Res, August 15, 1999; 43(3): 572 - 579. [Full Text] [PDF]
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R. Varin, P. Mulder, V. Richard, F. Tamion, C. Devaux, J.-P. Henry, F. Lallemand, G. Lerebours, and C. Thuillez Exercise Improves Flow-Mediated Vasodilatation of Skeletal Muscle Arteries in Rats With Chronic Heart Failure : Role of Nitric Oxide, Prostanoids, and Oxidant Stress Circulation, June 8, 1999; 99(22): 2951 - 2957. [Abstract] [Full Text] [PDF]
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R.P. Wielenga, I.A. Huisveld, E. Bol, P.H.J.M. Dunselman, R.A.M. Erdman, M.R.P. Baselier, and W.L. Mosterd Safety and effects of physical training in chronic heart failure. Results of the Chronic Heart Failure and Graded Exercise study (CHANGE): (CHANGE) Eur. Heart J., June 2, 1999; 20(12): 872 - 879. [Abstract] [PDF]
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P. Clarkson, H. E. Montgomery, M. J. Mullen, A. E. Donald, A. J. Powe, T. Bull, M. Jubb, M. World, and J. E. Deanfield Exercise training enhances endothelial function in young men J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1379 - 1385. [Abstract] [Full Text] [PDF]
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 M. Krzanowski, A. Surdacki, R. Nizankowski, A. Szczeklik, J. S. Dubiel, and P. Petkow Dimitrow Impaired Response of the Forearm Resistance but not Conductance Vessels to Reactive Hyperemia in Hypertrophic Cardiomyopathy Angiology, April 1, 1999; 50(4): 267 - 272. [Abstract] [PDF]
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J. Niebauer, A. J. Maxwell, P. S. Lin, P. S. Tsao, J. Kosek, D. Bernstein, and J. P. Cooke Impaired aerobic capacity in hypercholesterolemic mice: partial reversal by exercise training Am J Physiol Heart Circ Physiol, April 1, 1999; 276(4): H1346 - H1354. [Abstract] [Full Text] [PDF]
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A. J. S. Coats Exercise Training for Heart Failure : Coming of Age Circulation, March 9, 1999; 99(9): 1138 - 1140. [Full Text] [PDF]
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R. Belardinelli, D. Georgiou, G. Cianci, and A. Purcaro Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure : Effects on Functional Capacity, Quality of Life, and Clinical Outcome Circulation, March 9, 1999; 99(9): 1173 - 1182. [Abstract] [Full Text] [PDF]
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W. Johnson, C. Lucas, L. W. Stevenson, and M. A. Creager Effect of intensive therapy for heart failure on the vasodilator response to exercise J. Am. Coll. Cardiol., March 1, 1999; 33(3): 743 - 749. [Abstract] [Full Text] [PDF]
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M. B. Patel, I. V. Kaplan, R. N. Patni, D. Levy, J. A. Strom, J. Shirani, and T. H. LeJemtel Sustained Improvement in Flow-Mediated Vasodilation After Short-Term Administration of Dobutamine in Patients With Severe Congestive Heart Failure Circulation, January 12, 1999; 99(1): 60 - 64. [Abstract] [Full Text] [PDF]
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M. L. Muiesan, M. Salvetti, C. Monteduro, D. Rizzoni, R. Zulli, C. Corbellini, C. Brun, and E. Agabiti-Rosei Effect of Treatment on Flow-Dependent Vasodilation of the Brachial Artery in Essential Hypertension Hypertension, January 1, 1999; 33(1): 575 - 580. [Abstract] [Full Text] [PDF]
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J. Hansen, D. Sayad, G. D. Thomas, G. D. Clarke, R. M. Peshock, and R. G. Victor Exercise-induced attenuation of alpha-adrenoceptor mediated vasoconstriction in humans: evidence from phase-contrast MRI Cardiovasc Res, January 1, 1999; 41(1): 220 - 228. [Abstract] [Full Text] [PDF]
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B. Hornig, N. Arakawa, D. Haussmann, and H. Drexler Differential Effects of Quinaprilat and Enalaprilat on Endothelial Function of Conduit Arteries in Patients With Chronic Heart Failure Circulation, December 22, 1998; 98(25): 2842 - 2848. [Abstract] [Full Text]
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H. Drexler Endothelium as a Therapeutic Target in Heart Failure Circulation, December 15, 1998; 98(24): 2652 - 2655. [Full Text] [PDF]
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