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CLINICAL STUDY: HEART FAILURE

Endothelial dysfunction in patients with chronic heart failure: systemic effects of lower-limb exercise training

^a University of Leipzig, Heart Center, Division of Cardiology, Leipzig, Germany

Manuscript received January 21, 2000; revised manuscript received August 18, 2000, accepted October 2, 2000.

Reprint requests and correspondence: Priv.-Doz. Dr. med. Rainer Hambrecht, Associate Professor of Medicine, University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Russenstrasse 19, Leipzig 04289, Germany
hamr{at}server3.medizin.uni-leipzig.de

OBJECTIVES

We sought to analyze the systemic effects of lower-limb exercise training (ET) on radial artery endothelial function in patients with chronic heart failure (CHF).

BACKGROUND

Local ET has the potential to improve local endothelial dysfunction in patients with CHF. However, it remains unclear whether the systemic effects can be achieved by local ET.

METHODS

Twenty-two male patients with CHF were prospectively randomized to either ET on a bicycle ergometer (ET group, n = 11; left ventricular ejection fraction [LVEF] 26 ± 3%) or an inactive control group (group C, n = 11; LVEF 24 ± 2%). At the beginning of the study and after four weeks, endothelium-dependent and -independent vasodilation of the radial artery was determined by intra-arterial infusion of acetylcholine (ACh—7.5, 15 and 30 µg/min) and nitroglycerin (0.2 mg/min). The mean internal diameter (ID) of the radial artery was assessed using a high resolution ultrasound system (NIUS-02, Asulab Research Laboratories, Neuchâtel, Switzerland) with a 10-MHz probe.

RESULTS

After four weeks of ET, patients showed a significant increase in the baseline-corrected mean ID in response to ACh (30 µg/min), from 33 ± 10 to 127 ± 25 µm (p < 0.001 vs. control group at four weeks). In the control group, the response to ACh (30 µg/min) remained unchanged. Endothelium-independent vasodilation was similar in both groups at the beginning of the study and at four weeks. In the training group, increases in agonist-mediated, endothelium-dependent vasodilation correlated to changes in functional work capacity (r = 0.63, p < 0.05).

CONCLUSIONS

In patients with stable CHF, bicycle ergometer ET leads to a correction of endothelial dysfunction of the upper extremity, indicating a systemic effect of local ET on endothelial function.

Abbreviations and Acronyms   ACh = acetylcholine   BP = blood pressure   CHF = chronic heart failure   eNOS = endothelial nitric oxide synthase   ET = exercise training   FDVD = flow-dependent vasodilation   ID = internal diameter   LVEF = left ventricular ejection fraction   NO = nitric oxide   NTG = nitroglycerin   NYHA = New York Heart Association

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