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

Objectives We sought to analyze the systemic effects of lower-limb exercise training (ET) on radial artery endothelial function in patients with chron ic heart failure (CHF). Background Local ET has the potential to improve loca: endothelial dysfunct ion 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 ejecti on fraction [LVEF] 26 +/- 3%) or an inactive control group (group C, n = 11 ; LVEF 24 +/- 2%). At the beginning of the study and alter four weeks, endo thelium-dependent and -independent vasodilation of the radial artery was de termined by intra-arterial infusion of acetylcholine (ACh-7.5, 15 and 30 mu g/min) and nitroglycerin (0.2 mg/min). The mean internal diameter (ID) of t he radial artery was assessed using a high resolution ultrasound system (NI US-02, Asulab Research Laboratories, Neuchatel,Switzerland) with a 10-MHz p robe. Results After four weeks of ET, patients showed a significant increase in I D in response to ACh (30 mug/min), from 33 +/- 10 to 127 +/- 25 mum (p < 0. 001 vs. control group at four weeks). In the control group, the response to ACh (30 <mu>g/min) remained unchanged. Endothelium-independent vasodilatio n was similar in both groups at the beginning of the study and at four week s. In the training group, increases in agonist-mediated, endothelium-depend ent vasodilation correlated to changes in functional work capacity (r = 0.6 3, p < 0.05). Conclusions In patients with stable CHF, bicycle ergometer ET leads to a co rrection of endothelial dysfunction of the upper extremity, indicating a sy stemic effect of local ET on endothelial function. (C) 2001 by the American College of Cardiology.