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Endurance training improves oxidative stress and vascular endothelial dysfunction in patients with chronic heart failure (CHF). However, patients with CHF and an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have reported that stretching exercises enhance antioxidant activity and improve vascular responses. Therefore, we aimed to assess the effects of 4 weeks of stretching exercises on oxidative stress and vascular endothelial function in patients with CHF with an ICD or CRT-D.Fifty sedentary patients with CHF (78% males; mean age = 70 ± 9 years; left ventricular ejection fraction = 26% ± 8%) with an ICD or CRT-D were randomly divided into a group that performed 4 weeks of stretching exercises (stretching group) and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry (RH-PAT) index and blood parameters, such as von Willebrand factor (vWF), malondialdehyde-modified low-density lipoprotein cholesterol (MDA-LDL), reactive oxygen species (ROS), high-sensitivity C-reactive protein, pentraxin 3, and fibrinogen between the 2 groups before and after the 4-week study period.In the stretching group, a significant increase in the RH-PAT index and significant decreases in vWF, MDA-LDL, ROS, and fibrinogen concentrations were observed after the study compared with before (all P.05). No significant changes were observed in the control group.Four weeks of stretching exercises improved vascular endothelial dysfunction through attenuation of oxidative stress in sedentary patients with CHF with an ICD or CRT-D.

Introduction: Patients with hypertension (HT) are known to show an increased activity of renin-angiotensin-aldosterone system (RAAS) secondary to sympathetic hyperactivity. The RAAS hyperactivity was reported to induce vascular endothelial dysfunction and elevated functional arterial stiffness resulting in an inappropriate cardiovascular response during exercise such as an excessive blood pressure (BP) elevation. This study investigated whether a long-term RAAS inhibition ameliorated the inappropriate cardiovascular response during exercise in HT patients. Methods: Eighty HT patients (64±14 years, 48 males) were divided into two groups based on antihypertensives: angiotensin II receptor blocker (ARB) group and L-type calcium channel blocker (CCB) group. Patients were followed up for one year, after their BP was controlled below 140/90 mmHg. Patients received a cycle ergometer test, and blood examination before and after the follow-up period. We determined systolic blood pressure (SBP) elevation during the exercise test as the change from baseline SBP to peak SBP (ΔSBP). We assessed the changes in plasma renin, aldosterone, noradrenaline (NORA) and adrenaline (ADRN), and brachial-ankle pulse wave velocity (PWV) before and after the exercise test (ΔNORA and ΔADRN as sympathetic activity parameters and ΔPWV as a functional arterial stiffness). Results: ΔSBP after the follow-up period was significantly lower in the ARB group than in the CCB group (P Conclusions: RAAS inhibition prevented the arterial stiffness elevation resulting in the amelioration of inappropriate cardiovascular response during exercise in HT patients.

Background: Patients with chronic heart failure (CHF) are frequently readmitted to the hospital. Six-minute walk distance (6MWD) is a clinical measure to assess their exercise capacity and prognosis. However, few reports documented whether the 6MWD reflects the exercise capacity and prognosis in elderly CHF patients. Purpose: This study aimed to investigate whether the 6MWD measured at the hospital discharge predicted the readmission due to decompensated CHF in early elderly and late elderly CHF patients. Methods: Patients who were admitted to the hospital were prospectively followed up for 3 years after the discharge, if they had the first hospitalization due to CHF with NYHA III or IV. Consequently, we studied 177 patients (74±6 years, 112 males) and investigated their 6MWD at the discharge and readmission over 3 years. Patients were divided into 2 groups: early elderly group (65-74 years; n=108) and late elderly group (≥75 years; n=62). We determined significant factors affecting the readmission due to CHF and their cut-off values in the two groups using multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve. Results: 50 % of early elderly patients and 42 % of late elderly patients were readmitted within 3 year after the discharge. The multivariate logistic regression analysis detected the 6MWD at the discharge as a significant limiting factor for readmission in the two groups (P Conclusion: This study demonstrated that the 6MWD was shown as a strong predictor for readmission due to decompensated heart failure in elderly patients with CHF. The predictive cut-off values of 6MWD were 405 and 345 meters in the early elderly and late elderly patients, respectively.

Background: Elevated activity of renin-angiotensin-aldosterone system (RAAS) is known to induce vascular endothelial dysfunction in patients with lifestyle related disease such as diabetes mellitus (DM), hypertension (HT) and dyslipidemia (DL). Because the vascular endothelial dysfunction disturbs an appropriate blood flow to skeletal muscles, it is considered that the oxygen metabolism is impaired in them. Although eicosapentaenoic acid (EPA) has been reported to inhibit the RAAS, it is unclear whether EPA ameliorates vascular endothelial dysfunction via the RAAS inhibition resulting in the improvement of muscle oxygen metabolism. This study investigated the effects of EPA on vascular endothelial function and muscle oxygen metabolism during exercise in patients with lifestyle related disease. Methods: Ninety-two patients (68±8 years, 50 males) were divided into two groups based on the EPA administration in crossover method, after their DM, HT and/or DL were optimally treated. When patients took 1,800 mg of EPA daily for 8 months or not, they were in the EPA(+) group or in the EPA(-) group. In the end of each treatment period, cardiopulmonary exercise test was performed to measure oxygen uptake (VO 2 ) at anaerobic threshold (VO 2 AT ), peak VO 2 and the time from the start of the test to the AT (Time AT ) and endpoint (Time EP ). We measured serum EPA, plasma renin activity (PRA), aldosterone (ALD), adrenalin (ADRN) and noradrenalin (NORA), and reactive hyperemia index (RHI). We used the changes in PRA, ALD, ADRN and NORA before and after a cycle ergometer exercise test (ΔPRA, ΔALD, ΔADRN and ΔNORA) as neurohumoral factors, RHI as a parameter of vascular endothelial function and Time EP as an exercise capacity. Results: There were no significant differences in ΔPRA, ΔALD, ΔNORA, peak VO 2 and Time EP between the two groups. The PRA, ALD and ΔADRN were significantly lower in the EPA(+) group than in the EPA(-) group (P2 AT and Time AT were significantly higher in the EPA(+) group than in the EPA(-) group (P Conclusion: Long-term administration of EPA ameliorated vascular endothelial dysfunction via the RAAS inhibition resulting in the improvement of muscle oxygen metabolism in lifestyle related disease patients.

Background: Elderly patients with chronic heart failure (CHF) is well known to have poor activities of daily living (ADL) after hospital discharge because of their prolonged hospital stays and subsequent physical deconditioning. Although many studies demonstrated that decreased six-minute walk distance (6MWD) was an independent predictor of rehospitalization and mortality in them, the relationship between decreased 6MWD and poor ADL is not thoroughly evaluated. The purpose of this study was to investigate whether decreased 6MWD measured at hospital discharge reflected poor ADL after discharge in elderly patients with CHF. Methods: We recruited 290 patients, 179 males and 111 females, who were 65 years or more and admitted to our hospital because of first heart failure. We excluded the patients who had needed assistance with ADL or walking aid before admission. Plasma brain natriuretic peptide, left ventricular ejection fraction, 6MWD and motor functions including isometric quadriceps strength and one-leg standing time were measured at hospital discharge. ADL was evaluated using the performance measure for ADL-8 (PMADL-8) 3 months after discharge, while PMADL-8 score of 20 or more indicated poor ADL. To determine significant predictors affecting poor ADL and their cut-off values, a multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve were performed. Results: Patients’ mean age was 75.4 ± 6.4 years old and their mean PMADL-8 and 6MWD were 18.9 ± 5.9 points and 379 ± 109 meters, respectively. The univariate logistic regression analysis showed that age, 6MWD, quadriceps strength, one-leg standing time were significant predictors for PMADL-8 of ≥20 points (P Conclusions: Decreased 6MWD at hospital discharge was identified as an independent strong predictor for poor ADL after discharge in elderly patients with CHF, and its cut-off value was 370 meters.