Effects of exercise training on nitric oxide metabolites in heart failure with reduced or preserved ejection fraction: a secondary analysis of the SMARTEX-HF and OptimEx-Clin trials.

IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European journal of preventive cardiology Pub Date : 2025-03-14 DOI:10.1093/eurjpc/zwaf142
Sophia Marie-Theres Dinges, Edzard Schwedhelm, Julia Schoenfeld, Andreas B Gevaert, Ephraim B Winzer, Bernhard Haller, Flavia Baldassarri, Axel Pressler, André Duvinage, Rainer Böger, Axel Linke, Volker Adams, Burkert Pieske, Frank Edelmann, Håvard Dalen, Torstein Hole, Alf Inge Larsen, Patrick Feiereisen, Trine Karlsen, Eva Prescott, Øyvind Ellingsen, Emeline M Van Craenenbroeck, Martin Halle, Stephan Mueller
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Abstract

Aims: Exercise has been shown to affect the nitric oxide (NO) pathway, which is involved in the pathophysiology of endothelial dysfunction in heart failure (HF) with reduced (HFrEF) and preserved ejection fraction (HFpEF). However, the effects of different exercise modes on NO metabolites in patients with HF are uncertain.

Methods: Blood samples from two randomized controlled HF trials evaluating 1.) high-intensity-interval-training (HIIT), 2.) moderate-continuous-training (MCT) or 3.) a control group (CG) in HFrEF (SMARTEX-HF) and HFpEF (OptimEx-Clin) were analysed for NO metabolites L-arginine, homoarginine (hArg), asymmetric and symmetric dimethylarginine (ADMA; SDMA). Metabolite plasma concentrations were compared between HFrEF and HFpEF at baseline and within each HF type after 3 months of supervised exercise training and 12 month-follow-up.

Results: Overall, 206 patients with HFrEF (61±12 years, 18.9% females) and 160 with HFpEF (70±8 years, 65.6% females) were investigated. Baseline hArg (1.74±0.78 vs. 1.31±0.69 µmol/l) and ADMA (0.68±0.15 vs. 0.62±0.09 µmol/l) were significantly higher in HFrEF (p<0.001). NO metabolites showed several significant associations with markers of HF severity like exercise capacity (VO2peak) and NT-proBNP, but not with measures of endothelial function (reactive hyperaemia index, flow-mediated dilation). After 3 months of exercise and 12-month-follow-up, changes in metabolite plasma levels were not significantly different between study groups (HIIT, MCT or CG) (pgroup*time >0.05), neither in HFrEF nor HFpEF.

Conclusion: Baseline NO metabolite profile was unfavourable in patients with HF and lower VO2peak or higher NT-proBNP. We did not find a significant influence of HIIT or MCT on NO metabolites at 3 and 12 months.

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来源期刊
European journal of preventive cardiology
European journal of preventive cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
12.50
自引率
12.00%
发文量
601
审稿时长
3-8 weeks
期刊介绍: European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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