Functional electrical stimulation improves endothelial function and reduces peripheral immune responses in patients with chronic heart failure.

Apostolos I Karavidas, Kostadinos G Raisakis, John T Parissis, Dorothea K Tsekoura, Stamatis Adamopoulos, Dimitrios A Korres, Dimitrios Farmakis, Achilleas Zacharoulis, Ioannis Fotiadis, Evaggelos Matsakas, Apostolos Zacharoulis
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引用次数: 82

Abstract

Background: Previous studies have shown beneficial effects of functional electrical stimulation (FES) on muscle performance and exercise capacity of patients with chronic heart failure. This study evaluates the impact of FES on endothelial function and peripheral markers of immune activation in patients with moderate to severe heart failure.

Methods: Twenty-four patients with a left ventricular ejection fraction of less than 40% and New York Heart Association class II-III symptoms, undergoing optimized drug therapy, were randomly assigned (2 : 1) to a 6-week training programme of FES (n=16) or served as controls (n=8). Endothelial function was assessed by Doppler flow-mediated dilatation (FMD) of the brachial artery before and after the training programme. Peripheral pro-inflammatory/anti-inflammatory markers such as tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, soluble intercellular adhesion molecule (sICAM)-1, soluble vascular cell adhesion molecule (sVCAM)-1 and IL-10 were also measured before and after training.

Results: A significant improvement on the 6-min walk test (7.5+/-3.3%), Minnesota Living Score (18.2+/-8.6%) and FMD (38.5+/-15.1%) was observed only in the FES-treated group. FES also causes a significant reduction of TNF-alpha (-11.5+/-8.9%), sICAM-1 (-13.1+/-9.8%), and sVCAM-1 (-10.6+/-6.6%), as well as a respective increase in the ratio IL-10/TNF-alpha (37.1+/-29.4%). In the FES group, the percentage improvement in the Minnesota Living Score was significantly correlated with respective changes in circulating TNF-alpha (r=0.624, P<0.01), sVCAM-1 (r=0.665, P<0.001) and the ratio IL-10/TNF-alpha (r=-0.641, P<0.01).

Conclusion: FES is an exercise training programme that improves endothelial function in patients with chronic heart failure, and also has anti-inflammatory effects.

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功能性电刺激可改善慢性心力衰竭患者的内皮功能并降低外周免疫反应。
背景:先前的研究表明功能性电刺激(FES)对慢性心力衰竭患者的肌肉表现和运动能力有有益的影响。本研究评估了FES对中重度心力衰竭患者内皮功能和免疫激活外周标志物的影响。方法:24例左心室射血分数小于40%且有纽约心脏协会II-III级症状且正在接受优化药物治疗的患者,随机(2:1)分配到FES的6周训练计划中(n=16)或作为对照组(n=8)。在训练计划前后,通过多普勒血流介导扩张(FMD)评估肱动脉内皮功能。同时测定训练前后外周血促炎/抗炎指标,如肿瘤坏死因子(TNF)- α、白细胞介素(IL)-6、可溶性细胞间粘附分子(sICAM)-1、可溶性血管细胞粘附分子(sVCAM)-1和IL-10。结果:仅在fes治疗组,6分钟步行测试(7.5+/-3.3%)、明尼苏达生活评分(18.2+/-8.6%)和FMD(38.5+/-15.1%)均有显著改善。FES还导致tnf - α(-11.5+/-8.9%)、sICAM-1(-13.1+/-9.8%)和sVCAM-1(-10.6+/-6.6%)显著降低,IL-10/ tnf - α比值分别升高(37.1+/-29.4%)。在FES组中,明尼苏达州生活评分的改善百分比与各自循环tnf - α的变化显著相关(r=0.624, p)。结论:FES是一种运动训练方案,可改善慢性心力衰竭患者的内皮功能,并具有抗炎作用。
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