P4907Do patients with heart failure have equal response of endothelial function to exercise training: preserved vs reduced ejection fraction?

Abstract

Purpose: To examine the reaction of endothelium, assess through changes of circulating blood markers of endothelial function: the stable end product of nitric oxide (NOx), dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and xanthine oxidase (XO), that promotes exercise training in patients (pts) with heart failure with preserved ejection fraction (HFpEF) vs. pts with heart failure with reduced ejection fraction (HFrEF). Methods: 62 pts after myocardial infarction: 35 with HFpEF (HFpEF group) and 27 HFrEF (HFrEF group) were studied. In all pts, before and after a short-term supervised 3 weeks exercise training at residential center values of NOx, ADMA, SDMA and XO were determined and exercise test was performed. Results: After 3 weeks of exercise training NOx increased significantly in both groups: in HFpEF group (from 33.9±6.7 to 41.7±8.5 μmol/l, P<0.0001), and in HFrEF group (from 32.5±4.3 to 39.0±7.7 μmol/l, P<0.001). Value of ADMA as well of SDMA decreased in both groups after 3 weeks: ADMA in HFpEF group from 0.360±0.07 to 0.315±0.12 μmol/l (by 12.5%; P=0.059), and in HFrEF group from 0.280±0.07 to 0.264±0.06 μmol/l (by 5.7%; ns); SDMA in HFpEF group from 0.290±0.09 to 0.250±0.14 μmol/l (by 13.7%; ns), and in HFrEF group from 0.260±0.08 to 0.230±0.05 μmol/l (by 11.5%; ns). Compared to the baseline, value of XO after 3 weeks was significantly lower in both groups (P<0.0001 both), however it was significantly lower in HFpEF than in HFrEF group (190.5±33.0 vs 220.0±20.2 μmol/l, P=0.0002). After 3 weeks exercise capacity significantly increased in HFpEF group (P<0.001), as well as in HFrEF (P<0.02) Conclusion: The way of endothelial response on exercise training, in addition to standard therapy, was equal in pts with HFpEF and in pts with HFrEF. Exercise training induced favorable modification of endothelial function, expressed through significant increased of NOx, decreased of ADMA, SDMA, and significant decreased of XO, which was more pronounced in pts withHFpEF than in pts with HFrEF.