Search

Background: Growth differentiation factor-15 (GDF-15) is considered to be a cardioprotective cytokine possessing antiapoptotic and antiproliferative properties. If GDF-15 plasma levels are influenced by percutanenous coronary intervention (PCI) or regular exercise training is currently not known., Methods: After successful revascularization by PCI with stent implantation 36 consecutive patients with stable angina pectoris were randomized to an exercise training program or to a control group. Patients were followed by serial measurements of GDF-15, high-sensitivity Troponin T (hsTNT) and N-terminal pro brain natriuretic peptide (NT-proBNP) levels in peripheral blood after PCI and during six months follow-up., Results: Plasma levels of GDF-15 showed an early response to PCI with a modest, but significant increase after 30 minutes (p = 0.007) peaking three hours after PCI. Levels of hsTNT rose 5-fold from baseline to 24 hours (p < 0.001) with a normalization at seven days post PCI. Changes in plasma levels of GDF-15, hsTNT and NT-proBNP were not significantly different between the training and control group during follow-up., Conclusions: GDF-15 levels show a modest transient increase in response to coronary intervention with stent implantation. Exercise training over six months does not affect plasma levels of GDF-15, hsTNT or NT-proBNP in patients with stable coronary artery disease.

Aims Patients with chest pain and normal coronary angiogram [angina with normal coronary arteries (ANOCA)] constitute a therapeutic problem with considerable functional limitation and reduced quality of life. The aims of the current pilot study were to (i) explore if a structured aerobic high-intensity interval training (HIT) program for 12 weeks was feasible in patients with ANOCA, and (ii) to assess mechanisms related to symptoms in this population. Methods and results Sixteen patients with ANOCA underwent a 3-month aerobic HIT program with one-to-one monitored exercise sessions on treadmill in a 4 min × 4 manner, three times a week. Four patients served as controls. Coronary flow velocity reserve (CFVR) transthoracic Doppler, flow-mediated vasodilation (FMD) and VO2max was measured at baseline and after 12 weeks. The average attendance to training sessions was 82.3% ± 10.1 (56–94). CFVR in the training group increased from 2.50 ± 0.48 to 3.04 ± 0.71 (P < 0.001) whereas FMD increased from 4.19 ± 2.42% to 8.28 ± 2.85% (P < 0.001). Improvement in CFVR correlated with the relative improvement in FMD (R = 0.45, P = 0.047). This was associated with an increase in VO2max from 28.75 ± 6.51 mL/kg/min to 31.93 ± 6.46 mL/kg/min (P < 0.001). Conclusion A 3-month program of monitored HIT was feasible, with high adherence resulting in improved functional capacity in patients with ANOCA. CFVR improved and this improvement was associated with improved FMD. ClinicalTrials.gov Identifier NCT02905630 [ABSTRACT FROM AUTHOR]

Background. Endothelial dysfunction is associated with increased risk for cardiovascular events in patients with coronary artery disease and may predict in-stent restenosis after percutaneous coronary intervention. We evaluated if endothelial dysfunction could predict clinical and angiographic restenosis in patients after percutaneous coronary intervention with stent implantation for angina pectoris or acute coronary syndrome. Methods. One hundred patients were consecutively included after successful percutaneous coronary intervention with stenting for angiographic single vessel disease. All patients were evaluated with ultrasound detection of brachial artery reactivity at four weeks and with a symptom limited exercise stress test at six months and were followed for the occurrence of clinical or angiographic restenosis for 18 ±± 6 months. Results. Twenty patients showed clinical signs of restenosis during 18 months follow-up and were referred to re-angiography. Patients with clinical restenosis had impaired flow mediated vasodilation compared to patients without clinical restenosis (5.8 ±± 3.4 vs. 9.0 ±± 4.8, p == 0.005). In multivariate analysis flow mediated vasodilation was the only independent predictor for the risk of clinical restenosis (OR 4.5, 95% CI 1.11 to 17.8). Conclusions. Impaired flow mediated vasodilation four weeks after percutaneous coronary intervention independently predicts the risk of clinical restenosis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Low time domain measures of heart rate variability (HRV) have been shown to predict outcome after myocardial infarction (MI). The predictive value of HRV, when measured in patients with coronary artery disease (CAD) without MI is less clear. Further, little is known about the mechanisms of how autonomic imbalance affects outcome. Methods and design: Forty patients following percutaneous coronary intervention (PCI) with stent implantation for angina pectoris were prospectively randomized to a six month supervised high-intensity interval training program (n =20) or to a control group (n =20). All patients underwent a 24-hour Holter monitoring to assess measures of HRV at baseline and at six months. Results: At baseline there were no significant differences between groups. In the training group all time domain indices and the frequency domain indices, total power and ultralow frequency of HRV, increased significantly during the training period. Mean heart rate decreased significantly. In the control group only the root mean square of differences between successive NN intervals (ln RMSSD) increased significantly. Changes in standard deviations of the average NN intervals (SDANN) and ln RMSSD were significantly correlated to changes in peak VO2 (R =0.47 and 0.39; p <0.01 and p =0.03 respectively). HRV measures were not significantly correlated to endothelial function. Conclusions: High-intensity exercise training over 6months significantly improved time and frequency domain measures of HRV in patients following PCI with stent implantation. The effect on HRV was correlated to changes in peak VO2, but not to changes in endothelial function. [ABSTRACT FROM AUTHOR]