Document Detail


Exercise training and endothelial dysfunction in coronary artery disease and chronic heart failure. From molecular biology to clinical benefits.
MedLine Citation:
PMID:  12032463     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Endothelial dysfunction (ED) has been documented in patients with both coronary artery disease (CAD) and chronic heart failure (CHF)-being responsible for exercise-induced myocardial ischemia in the former and increased afterload in the latter. In the last two decades exercise training has assumed a major role in both cardiovascular disorders. In CAD exercise training has established positive effects on myocardial perfusion. Recently, exercise training has been shown to attenuate paradoxical vasoconstriction in CAD. The improved ED after training explains the improvement of myocardial perfusion in the absence of changes in baseline coronary artery diameter. Since ED has been identified as a predictor of coronary events exercise may contribute to long-term reductions of cardiovascular mortality. In CHF the increased peripheral vascular resistance - especially during exercise - is more important. ED contributes to the peripheral vasoconstriction. Training programs have shown to improve ED in CHF. A long-term study of hemodynamic effects of training in CHF revealed a significant reduction of total peripheral resistance (TPR) that after 6 months with a concomitant increase in stroke volume. In a subgroup analysis a significant correlation between changes in TPR and changes in peripheral ED was observed. Cell culture and animal experiments suggest that shear stress increases the endothelial L-arginine uptake, enhances NO synthase activity and expression, and upregulates the production of extracellular superoxide dismutase, which prevents premature NO breakdown. All these molecular effects converge on a reduction of myocardial ischemic events in CAD and a decrease of afterload in CHF.
Authors:
S Gielen; S Erbs; G Schuler; R Hambrecht
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Minerva cardioangiologica     Volume:  50     ISSN:  0026-4725     ISO Abbreviation:  Minerva Cardioangiol     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-05-28     Completed Date:  2002-08-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0400725     Medline TA:  Minerva Cardioangiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  95-106     Citation Subset:  IM    
Affiliation:
University of Leipzig, Heart Center, Department of Internal Medicine, Cardiology, Leipzig, Germany.
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Coronary Disease / enzymology,  physiopathology*,  prevention & control*
Endothelium, Vascular / enzymology,  physiopathology*
Exercise*
Heart Failure / enzymology,  physiopathology*,  prevention & control*
Hemodynamics
Humans
Nitric Oxide / metabolism
Nitric Oxide Synthase / metabolism
Nitric Oxide Synthase Type III
Chemical
Reg. No./Substance:
10102-43-9/Nitric Oxide; EC 1.14.13.39/NOS3 protein, human; EC 1.14.13.39/Nitric Oxide Synthase; EC 1.14.13.39/Nitric Oxide Synthase Type III

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