Abstract 5077: Age-Related Changes in Endothelial Function in Patients with Chronic Heart Failure and Healthy Subjects - Effects of Exercise Training
BACKGROUND: Impairment of endothelial function may occur in both physiologic aging and chronic heart failure (CHF). It has, however, never been assessed, whether the degree of endothelial dysfunction in CHF patients is influenced by age and if the well established beneficial effects of endurance exercise training on endothelial function are diminished in old age.
METHODS: In this study we randomised 50 pts. with stable CHF (age 61.4±2.7 years, EF 26.3±1.5%, VO2max 13.8±2.3ml/kg*min) and 50 healthy subjects (HS) (age 59.8±3.1 years, EF 60±1%, VO2max 21.1±3.1 ml/kg*min) to a training (T) or a control group (C). To detect possible aging effects we included subjects below 55 (young) and above 65 years (old). Subjects in the T-group exercised 4 times daily at 60 to 70% of VO2max for 4 weeks under supervision. At baseline and after the intervention, flow-mediated dilatation (FMD) was assessed by a high-resolution radial ultrasound (NIUS2).
RESULTS: As compared to young HS, old HS showed at baseline a reduced FMD (young: 16.7±1.1%; old: 12.1±1.6%; p<0.05). In CHF patients, endothelial function was impaired (young 9.3±0.9%; old: 9.1±1.2%). No difference of these baseline parameters between the age groups was observed in patients with CHF (p=0.72). As a result of ET, FMD improved from 12.2±0.9% to 15.9±1.2% in old HS (p<0.05), while it remained unchanged in young training HS and C respectively. In young and old patients with CHF four weeks of ET resulted in a significant change in FMD (young: from 9.2±0.8 to 13.1±1.2; p<0.05; old: from 9.0±1.1 to 12.4±1.0 p<0.05). In C no effect was detectable.
CONCLUSIONS: The present trial provides new insight into the age-dependency of cardiovascular training effects: Among HS aging is associated with the development of endothelial dysfunction. In CHF both young and old patients exhibit a similar degree of endothelial dysfunction. Four weeks of ET are effective in improving endothelial dysfunction in old HS and in all age groups of CHF patients. The training effect was not significantly diminished among older patients with underlining the potentials of rehabilitation interventions in this patient group, where CHF is most prevalent.