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CLINICAL STUDY: HEART FAILURE

Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure

Takashi Kihara, MD^*, Sadatoshi Biro, MD^*, Masakazu Imamura, MD^*, Shiro Yoshifuku, MD^*, Kunitsugu Takasaki, MD^*, Yoshiyuki Ikeda, MD^*, Yutaka Otuji, MD^*, Shinichi Minagoe, MD^*, Yoshifumi Toyama, MD and Chuwa Tei, MD, FACC^*,*

^* First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
Nanpuh Hospital, Kagoshima, Japan

Manuscript received December 21, 2000; revised manuscript received November 28, 2001, accepted December 12, 2001.

^* Reprint requests and correspondence: Dr. Chuwa Tei, First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan.
chuwatei{at}med5.kufm.kagoshima-u.ac.jp

OBJECTIVES: The purpose of this study was to determine the mechanism by which 60°C sauna treatment improves cardiac function in patients with chronic heart failure (CHF).

BACKGROUND: We have previously reported that repeated 60°C sauna treatment improves hemodynamic data and clinical symptoms in patients with CHF. We hypothesized that the sauna restores endothelial function and then improves cardiac function.

METHODS: Twenty patients (62 ± 15 years) in New York Heart Association (NYHA) functional class II or III CHF were treated in a dry sauna at 60°C for 15 min and then kept on bed rest with a blanket for 30 min, daily for two weeks. Ten patients with CHF, matched for age, gender and NYHA functional class, were placed on a bed in a temperature-controlled (24°C) room for 45 min as the nontreated group. Using high-resolution ultrasound, we measured the diameter of the brachial artery at rest and during reactive hyperemia (percent flow-mediated dilation, %FMD: endothelium-dependent dilation), as well as after sublingual administration of nitroglycerin (%NTG: endothelium-independent dilation). Cardiac function was evaluated by measuring the concentrations of plasma brain natriuretic peptide (BNP).

RESULTS: Clinical symptoms were improved in 17 of 20 patients after two weeks of sauna therapy. The %FMD after two-week sauna treatment significantly increased from the baseline value, whereas the %NTG-induced dilation did not. Concentrations of BNP after the two-week sauna treatment decreased significantly. In addition, there was a significant correlation between the change in %FMD and the percent improvement in BNP concentrations in the sauna-treated group. In contrast, none of the variables changed at the two-week interval in the nontreated group.

CONCLUSIONS: Repeated sauna treatment improves vascular endothelial function, resulting in an improvement in cardiac function and clinical symptoms.

Abbreviations and Acronyms   LVEDD   ANP   atrial natriuretic peptide   BNP   brain natriuretic peptide   CHF   chronic heart failure   CTR   cardiothoracic ratio   eNOS   endothelial nitric oxide synthase   %FMD   percent flow-mediated dilation   LVEDD   left ventricular end-diastolic dimension   NO   nitric oxide   %NTG   percent nitroglycerin   NYHA   New York Heart Association   TBARS   thiobarbituric acid-reactive substances   TNF   tumor necrosis factor

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