Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Θεόδωρος Πιτταράς, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Σεραφείμ Νανάς, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αναστασία Κοτανίδου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Χριστίνα Ρούτση, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Βασιλειάδης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικολέττα Ροβίνα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αναστάσιος Φιλίππου, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η επίδραση της άσκησης στη λειτουργία του αγγειακού ενδοθηλίου σε ασθενείς με χρόνια καρδιακή ανεπάρκεια
Translated title:
The effect of exercise on the vascular endothelial function in patients with chronic heart failure
Summary:
Introduction: Chronic heart failure (CHF) is a multifactorial clinical syndrome and remains a significant cause of morbidity and mortality with social and economic burden. Vascular endothelial dysfunction is an underlying pathophysiological feature of CHF. Endothelial progenitor cells (EPCs) have been proven to be involved in the shielding of the vascular protection, the restoring of the dysfunctional endothelium, the promotion of angiogenesis and the regulation of the vascular homeostasis. Exercise has a beneficial effect in the function of the vascular endothelium and enhances the mobilization of EPCs from the bone marrow by having a positive effect on both the number of EPCs and their functional properties. We hypothesized that exercise stimulates the mobilization of EPCs, both in acute and long-term phase, in patients with CHF.
The main aim of this study was to assess and quantify the acute mobilization of EPCs and circulating endothelial cells (CECs) after maximal exercise, the long-term mobilization at rest after a cardiac rehabilitation (CR) program and the acute response of EPCs and CECs after maximal exercise under the effect of the CR program in patients with CHF. The secondary aim was to investigate whether there were differences between patients of different CHF severity and different exercise training protocols.
Methods: Forty-four patients (35 males) with stable CHF enrolled in a 36-session CR program and were randomized by stratification (based on age and peak VO2) in one training protocol; either high-intensity interval training (HIIT) or HIIT combined with muscle strength (COM). All patients underwent maximum cardiopulmonary exercise testing (CPET) before and after the CR program and venous blood was drawn before and after each CPET. Five circulating endothelial populations were quantified by flow cytometry: 3 subgroups of EPCs (CD34+/CD45-/CD133+, CD34+/CD45-/CD133+ /VEGFR2 and CD34+/CD133+/VEGFR2) and 2 subgroups of CECs (CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2). EPCs values are expressed in median (25th - 75th percentiles) as cells/106 enucleated cells. In addition, CPET indexes were assessed while C reactive protein (CRP) and vascular endothelial growth factor (VEGF) were quantified. Patients were divided in two groups of severity according to peak VO2, predicted peak VO2, VE/VCO2 slope and ejection fraction (EF).
Results: In total sample, an increase in both the acute mobilization after maximal CPET and the long-term mobilization of all endothelial cellular populations at rest after the cardiac rehabilitation program was observed (p < 0.05). After the CR program, the acute response of endothelial cellular populations’ mobilization after maximal exercise was higher in the final CPET compared to the initial CPET in CD34+/CD45-/CD133+, CD34+/CD45-/CD133+ /VEGFR2, CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2 (p < 0.05). The CR program improved CPET indexes such as peak VO2, predicted peak VO2, VE/VCO2 slope and peak work rate while it reduced CRP and increased VEGF (p < 0.05).
Although there was improvement in all of the above variables within each severity group and each group of different exercise protocol (p < 0.05), no differences were observed in the comparison between groups (p > 0.05).
Conclusions: A single session of a symptom-limited maximal CPET stimulates the acute mobilization of EPCs and CECs in patients with CHF. A 36-session cardiac rehabilitation program increases the long-term mobilization of EPCs and CECs at rest and the acute response after maximal exercise in patients with CHF. Moreover, it improves aerobic exercise capacity, reduces CRP and increases VEGF. The benefits of exercise appear to be similar for patients of different CHF severity and patients with different exercise training protocols. However, further investigation for better understanding of the pathophysiological mechanisms is required.
Main subject category:
Health Sciences
Keywords:
Chronic heart failure, Exercise, Rehabilitation, Endothelial progenitor cells, Cardiopulmonary exercise testing, Severity
Number of references:
160
