Document Detail

Exercise training in patients with advanced chronic heart failure (NYHA IIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function.
MedLine Citation:
PMID:  20430934     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Attenuated peripheral perfusion in patients with advanced chronic heart failure (CHF) is partially the result of endothelial dysfunction. This has been causally linked to an impaired endogenous regenerative capacity of circulating progenitor cells (CPC). The aim of this study was to elucidate whether exercise training (ET) affects exercise intolerance and left ventricular (LV) performance in patients with advanced CHF (New York Heart Association class IIIb) and whether this is associated with correction of peripheral vasomotion and induction of endogenous regeneration.
METHODS AND RESULTS: Thirty-seven patients with CHF (LV ejection fraction 24+/-2%) were randomly assigned to 12 weeks of ET or sedentary lifestyle (control). At the beginning of the study and after 12 weeks, maximal oxygen consumption (Vo(2)max) and LV ejection fraction were determined; the number of CD34(+)/KDR(+) CPCs was quantified by flow cytometry and CPC functional capacity was determined by migration assay. Flow-mediated dilation was assessed by ultrasound. Capillary density was measured in skeletal muscle tissue samples. In advanced CHF, ET improved Vo(2)max by +2.7+/-2.2 versus -0.8+/-3.1 mL/min/kg in control (P=0.009) and LV ejection fraction by +9.4+/-6.1 versus -0.8+/-5.2% in control (P<0.001). Flow-mediated dilation improved by +7.43+/-2.28 versus +0.09+/-2.18% in control (P<0.001). ET increased the number of CPC by +83+/-60 versus -6+/-109 cells/mL in control (P=0.014) and their migratory capacity by +224+/-263 versus -12+/-159 CPC/1000 plated CPC in control (P=0.03). Skeletal muscle capillary density increased by +0.22+/-0.10 versus -0.02+/-0.16 capillaries per fiber in control (P<0.001).
CONCLUSIONS: Twelve weeks of ET in patients with advanced CHF is associated with augmented regenerative capacity of CPCs, enhanced flow-mediated dilation suggestive of improvement in endothelial function, skeletal muscle neovascularization, and improved LV function. Clinical Trial Registration- Unique Identifier: NCT00176384.
Sandra Erbs; Robert Höllriegel; Axel Linke; Ephraim B Beck; Volker Adams; Stephan Gielen; Sven Möbius-Winkler; Marcus Sandri; Nicolle Kränkel; Rainer Hambrecht; Gerhard Schuler
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-04-29
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-21     Completed Date:  2010-08-10     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  486-94     Citation Subset:  IM    
Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
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MeSH Terms
Chronic Disease
Endothelium, Vascular / physiology*
Exercise Therapy / methods*
Exercise Tolerance / physiology
Follow-Up Studies
Heart Failure / diagnosis,  rehabilitation*
Leg / blood supply
Middle Aged
Muscle, Skeletal / blood supply,  physiology
Oxidative Stress / physiology
Prospective Studies
Recovery of Function
Regional Blood Flow / physiology
Risk Assessment
Sedentary Lifestyle
Severity of Illness Index
Stroke Volume / physiology*
Time Factors
Treatment Outcome
Vascular Resistance / physiology
Vasomotor System / physiology
Ventricular Function, Left / physiology*
Ventricular Remodeling / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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