title: Cardiac rehabilitation improves coronary endothelial function in patients with heart failure due to dilated cardiomyopathy: A positron emission tomography study.
abstract: BACKGROUND
  Endothelial dysfunction is common in patients with heart failure and is associated with poor clinical outcome. Cardiac rehabilitation is able to enhance peripheral endothelial function but its impact on coronary vasomotion remains unknown. We aimed to evaluate the effect of cardiac rehabilitation on coronary vasomotion in patients with heart failure.
  
  
  METHODS
  We prospectively enrolled 29 clinically stable heart failure patients from non-ischaemic dilated cardiomyopathy and without coronary risk factors. Myocardial blood flow was quantified using (15)-O water positron emission tomography at rest and during a cold pressor test, before and after 12 weeks of cardiac rehabilitation and optimization of medical therapy.
  
  
  RESULTS
  Rest myocardial blood flow was significantly improved after the completion of rehabilitation compared to baseline (1.31 ± 0.38 mL/min/g vs. 1.16 ± 0.41 mL/min/g, p = 0.04). The endothelium-related change in myocardial blood flow from rest to cold pressor test and the percentage of myocardial blood flow increase during the cold pressor test were both significantly improved after cardiac rehabilitation (respectively from -0.03 ± 0.22 mL/min/g to 0.19 ± 0.22 mL/min/g, p < 0.001 and from 101.5 ± 16.5% to 118.3 ± 24.4%, p < 0.001). Left ventricular ejection fraction, plasma levels of brain natriuretic peptide, maximal oxygen consumption and the Minnesota Living with Heart Failure Questionnaire score were also significantly improved. The improvement was not related to uptitration of medical therapy.
  
  
  CONCLUSIONS
  Coronary endothelial function is altered in patients with heart failure due to non-ischaemic dilated cardiomyopathy. In these patients, cardiac rehabilitation significantly improves coronary vasomotion.
authors.affiliation: Department of Cardiology, CHU de Caen, France Normandie Université, Caen, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Legallois
authors.affiliation: Department of Cardiac Surgery, CHU de Caen, France.
authors.forename: Annette
authors.initials: A
authors.lastname: Belin
authors.affiliation: Turku PET Centre, University of Turku, Finland IM Sechenov Institute of Evolutionary Physiology and Biochemistry, Russia Faculty of Medicine, Saint Petersburg State University, Russia.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Nesterov
authors.affiliation: Department of Cardiology, CHU de Caen, France Normandie Université, Caen, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Milliez
authors.affiliation: Department of Biostatistic and Clinical Research, CHU de Caen, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Parienti
authors.affiliation: Turku PET Centre, University of Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Knuuti
authors.affiliation: Inserm U1077, Caen, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Cyceron PET Centre, Caen, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tirel
authors.affiliation: Normandie Université, Caen, France Department of Nuclear Medicine, CHU de Caen, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Agostini
authors.affiliation: Normandie Université, Caen, France Cyceron PET Centre, Caen, France Department of Nuclear Medicine, CHU de Caen, France manrique@cyceron.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Manrique
mesh_terms: D000328:Adult; D000368:Aged; D017704:Baroreflex / Q000502:physiology; D001783:Blood Flow Velocity / Q000502:physiology; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology*; D003080:Cold Temperature; D003326:Coronary Circulation / Q000502:physiology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology
chemical_list: D010104:Oxygen Radioisotopes; D020097:Natriuretic Peptide, Brain
keywords: Dilated cardiomyopathy; coronary endothelial dysfunction; heart failure; positron emission tomography; rehabilitation