Regular Physical Exercise Corrects Endothelial Dysfunction and Improves Exercise Capacity in Patients With Chronic Heart Failure

Background—The purpose of this study was to determine the effects of systemic exercise training on endothelium-mediated arteriolar vasodilation of the lower limb and its relation to exercise capacity in chronic heart failure (CHF). Endothelial dysfunction is a key feature of CHF, contributing to increased peripheral vasoconstriction and impaired exercise capacity. Local handgrip exercise has previously been shown to enhance endothelium-dependent vasodilation in conduit and resistance vessels in CHF. Methods and Results—Twenty patients were prospectively randomized to a training group (n510, left ventricular ejection fraction [LVEF] 2464%) or a control group (n510, LVEF 2363%). At baseline and after 6 months, peak flow velocity was measured in the left femoral artery using a Doppler wire; vessel diameter was determined by quantitative angiography. Peripheral blood flow was calculated from average peak velocity (APV) and arterial cross-sectional area. After exercise training, nitroglycerin-induced endothelium-independent vasodilation remained unaltered (271 % versus 281%, P5NS). Peripheral blood flow improved significantly in response to 90 mg/min acetylcholine by 203 % (from 152679 to 4616104 mL/min, P,0.05 versus control group) and the inhibiting effect of L-NMMA increased by 174% (from 246625 to 2126619 mL/min, P,0.05 versus control group). Peak oxygen uptake increased by 26 % (P,0.01 versus control group). The increase in peak oxygen uptake was correlated with the endothelium-dependent change in peripheral blood flow (r50.64, P,0.005)