title: Influence of intensive physical training on urinary nitrate elimination and plasma endothelin-1 levels in patients with congestive heart failure.
abstract: BACKGROUND
  Congestive heart failure (CHF) is associated with increased peripheral vascular resistance. Exercise-induced shear stress may release endothelial relaxing factors, such as nitric oxide (NO), and inhibit the production of vasoconstrictors such as endothelin-1 (ET-1) thereby modulating vascular tone. We examined the effect of intensive training on ET-1 plasma concentrations and NO-metabolite elimination in patients with CHF after acute myocardial infarction.
  
  
  METHODS
  Seventeen patients with CHF after a myocardial infarction were randomized to an exercise group (n = 9), who performed physical training for 8 weeks, or a control group (n = 8) who received usual care. A physical examination, pulmonary function test, and a maximum exercise test were performed, and 24-hour urinary nitrate elimination and ET-1 in plasma were determined before and at the end of the study period.
  
  
  RESULTS
  Maximal oxygen uptake remained unchanged in controls (17.9 +/- 1.4 to 18.1 +/- 1.5 mL/(kg min) but increased in the exercise group (from 20.4 +/- 0.75 to 26.7 +/- 1.4 mL/(kg min). After 8 weeks the urinary nitrate elimination in controls was significantly decreased (1.25 +/- 0.20 to 1.03 +/- 0.22 mmol/24 hours; P < 0.001), while it was unchanged in the exercise group (1.26 +/- 0.23 to 1.39 +/- 0.28; P = 0.71). Plasma ET-1 levels did not change after 8 weeks (7.87 +/- 0.62 versus 7.57 +/- 0.75 and 7.13 +/- 0.6 versus 7.35 +/- 0.7 pg/mL for control and exercise groups, respectively).
  
  
  CONCLUSIONS
  In patients with CHF after acute myocardial infarction nitrate elimination decreases over the subsequent 2 months. This trend was reversed by training. Because nitrate elimination mirrors endogenous NO production, these results suggest that training may positively influence endothelial vasodilator function.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland.
authors.forename: Z
authors.initials: Z
authors.lastname: Callaerts-Végh
authors.forename: M
authors.initials: M
authors.lastname: Wenk
authors.forename: U
authors.initials: U
authors.lastname: Goebbels
authors.forename: G
authors.initials: G
authors.lastname: Dziekan
authors.forename: J
authors.initials: J
authors.lastname: Myers
authors.forename: P
authors.initials: P
authors.lastname: Dubach
authors.forename: W E
authors.initials: WE
authors.lastname: Haefeli
mesh_terms: D019332:Endothelin-1 / Q000097:blood*; D005081:Exercise Therapy; D006333:Heart Failure / Q000097:blood / Q000378:metabolism* / Q000652:urine; D006801:Humans; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000652:urine*; D010101:Oxygen Consumption; D011446:Prospective Studies
chemical_list: D019332:Endothelin-1; D009566:Nitrates