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Previous Volume 342:454-460 February 17, 2000 Number 7 Next

	Full Text PDF Editorial by Vita, J. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Studies of the cardioprotective effects of exercise training in patients with coronary artery disease have yielded contradictory results. Exercise training has been associated with improvement in myocardial perfusion even in patients who have progression of coronary atherosclerosis. We therefore conducted a prospective study of the effect of exercise training on endothelial function in patients with coronary artery disease.

Methods We randomly assigned 19 patients with coronary endothelial dysfunction, indicated by abnormal acetylcholine-induced vasoconstriction, to an exercise-training group (10 patients) or a control group (9 patients). To reduce confounding, patients with coronary risk factors that could be influenced by exercise training (such as diabetes, hypertension, hypercholesterolemia, and smoking) were excluded. In an initial study and after four weeks, the changes in vascular diameter in response to the intracoronary infusion of increasing doses of acetylcholine (0.072, 0.72, and 7.2 µg per minute) were assessed. The mean peak flow velocity was measured by Doppler velocimetry, and the diameter of epicardial coronary vessels was measured by quantitative coronary angiography.

Results In the initial study, the two groups had similar vasoconstrictive responses to acetylcholine. After four weeks of exercise training, coronary-artery constriction in response to acetylcholine at a dose of 7.2 µg per minute was reduced by 54 percent (from a mean [±SE] decrease in the luminal diameter of 0.41±0.05 mm in the initial study to a decrease of 0.19±0.07 mm at four weeks; P<0.05 for the comparison with the change in the control group). In the exercise-training group, the increases in mean peak flow velocity in response to 0.072, 0.72, and 7.2 µg of acetylcholine per minute were 12±7, 36±11, and 78±16 percent, respectively, in the initial study. After four weeks of exercise, the increases in response to acetylcholine were 27±7, 73±19, and 142±28 percent (P< 0.01 for the comparison with the control group). Coronary blood-flow reserve (the ratio of the mean peak flow velocity after adenosine infusion to the resting velocity) increased by 29 percent after four weeks of exercise (from 2.8±0.2 in the initial study to 3.6±0.2 after four weeks; P<0.01 for the comparison with the control group).

Conclusions Exercise training improves endothelium-dependent vasodilatation both in epicardial coronary vessels and in resistance vessels in patients with coronary artery disease.

Source Information

From the University of Leipzig Heart Center, Department of Medicine and Cardiology, Leipzig, Germany.

Address reprint requests to Dr. Hambrecht at the Herzzentrum, Universität Leipzig, Russenstr. 19, 04289 Leipzig, Germany, or at hamr{at}server3.medizin.uni-leipzig.de.

Full Text of this Article

Related Letters:

Exercise and Coronary Endothelial Function
Georgiou D., Belardinelli R., Hambrecht R., Gielen S., Schuler G.
Extract | Full Text  
N Engl J Med 2000; 343:147-148, Jul 13, 2000. Correspondence

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