Article

Endothelial dysfunction is common in patients with heart failure and
is associated with poor clinical outcome.
Cardiac rehabilitation is able to
enhance peripheral endothelial function but its impact on coronary vasomotion
remains unknown. We aimed to evaluate the effect of cardiac rehabilitation on
coronary vasomotion in patients with heart failure.
METHOD: We prospectively
enrolled 29 clinically stable heart failure patients from non-ischaemic dilated
cardiomyopathy and without coronary risk factors. Myocardial blood flow was
quantified using (15)-O water positron emission tomography at rest and during a
cold pressor test, before and after 12 weeks of cardiac rehabilitation and
optimization of medical therapy. RESULTS: Rest myocardial blood flow was
significantly improved after the completion of rehabilitation compared to
baseline (1.31 +/- 0.38 mL/min/g vs. 1.16 +/- 0.41 mL/min/g, p = 0.04). The
endothelium-related change in myocardial blood flow from rest to cold pressor
test and the percentage of myocardial blood flow increase during the cold pressor
test were both significantly improved after cardiac rehabilitation (respectively
from -0.03 +/- 0.22 mL/min/g to 0.19 +/- 0.22 mL/min/g, p < 0.001 and from 101.5
+/- 16.5% to 118.3 +/- 24.4%, p < 0.001). Left ventricular ejection fraction,
plasma levels of brain natriuretic peptide, maximal oxygen consumption and the
Minnesota Living with Heart Failure Questionnaire score were also significantly
improved. The improvement was not related to uptitration of medical therapy.
CONCLUSIONS: Coronary endothelial function is altered in patients with heart
failure due to non-ischaemic dilated cardiomyopathy. In these patients, cardiac
rehabilitation significantly improves coronary vasomotion.
CI - (c) The European Society of Cardiology 2014.

Langue : ANGLAIS