Claudia Walther

Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease A Randomized Trial

Background—Regular exercise in patients with stable coronary artery disease has been shown to improve myocardial perfusion and to retard disease progression. We therefore conducted a randomized study to compare the effects of exercise training versus standard percutaneous coronary intervention (PCI) with stenting on clinical symptoms, angina-free exercise capacity, myocardial perfusion, cost-effectiveness, and frequency of a combined clinical end point (death of cardiac cause, stroke, CABG, angioplasty, acute myocardial infarction, and worsening angina with objective evidence resulting in hospitalization). Methods and Results—A total of 101 male patients aged ≤70 years were recruited after routine coronary angiography and randomized to 12 months of exercise training (20 minutes of bicycle ergometry per day) or to PCI. Cost efficiency was calculated as the average expense (in US dollars) needed to improve the Canadian Cardiovascular Society class by 1 class. Exercise training was associated with a higher event-free survival (88% versus 70% in the PCI group, P =0.023) and increased maximal oxygen uptake (+16%, from 22.7±0.7 to 26.2±0.8 mL O2/kg, P <0.001 versus baseline, P <0.001 versus PCI group after 12 months). To gain 1 Canadian Cardiovascular Society class,

The effect of exercise training on endothelial function in cardiovascular disease in humans

6956 was spent in the PCI group versus

Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease.

3429 in the training group (P <0.001). Conclusions—Compared with PCI, a 12-month program of regular physical exercise in selected patients with stable coronary artery disease resulted in superior event-free survival and exercise capacity at lower costs, notably owing to reduced rehospitalizations and repeat revascularizations.

Effect of Increased Exercise in School Children on Physical Fitness and Endothelial Progenitor Cells A Prospective Randomized Trial

WALTHER, C., S. GIELEN, and R. HAMBRECHT. The effect of exercise training on endothelial function in cardiovascular disease in humans. Exerc. Sport Sci. Rev., Vol. 32, No. 4, pp. 129–134, 2004. Endothelial dysfunction occurs early in atherosclerosis in response to cardiovascular risk factors. The occurrence of endothelial dysfunction is primarily the result of reduced nitric oxide (NO) bioavailabilty. It represents an independent predictor of cardiovascular events and predicts the prognosis of the patient. Therefore, endothelial function has been identified as a target for therapeutic intervention. Regular exercise training is a nonpharmacological option to improve endothelial dysfunction in patients with cardiovascular disease by increasing NO bioavailability.

Exercise training in patients with severe chronic heart failure: impact on left ventricular performance and cardiac size. A retrospective analysis of the Leipzig Heart Failure Training Trial

Background Chronic vascular inflammation may trigger ischemic events whereas regular physical exercise training (ET) has shown to be cardioprotective in patients with coronary artery disease (CAD). We investigated the impact of 2 years regular ET versus percutaneous intervention (PCI) on chronic inflammation and cardiovascular events. Methods and results A total of 101 male patients with stable CAD and an indication for revascularization were prospectively randomized to regular ET (n = 51) or PCI with stentimplantation (n = 50). High-sensitive C-reactive protein and interleukin-6, exercise capacity and ischemic endpoints were analyzed at baseline and after 2 years. At 2 years maximal oxygen consumption (Vo2 max) increased by 10% in the ET group (23.3 ± 0.6 to 25.7 ± 1.0 ml O2/kg/min; P = 0.0171 versus baseline) versus 7% in the PCI group (22.3 ± 0.8 to 23.9 ± 1.2 ml O2/kg/min; P = 0.4248). In a subgroup of patients, high-sensitive C-reactive protein levels and interleukin-6 levels were significantly reduced after ET by 41 and 18%, respectively, whereas no relevant changes were observed in the PCI group. Event-free survival rates after 24 months were 78% (ET) versus 62% (PCI) (P = 0.039). Conclusion In patients with stable coronary artery disease, regular physical exercise is associated with a reduction of inflammatory markers and ischemic events.

Reduced number and function of endothelial progenitor cells in patients with aortic valve stenosis: a novel concept for valvular endothelial cell repair

Background— The aim of this prospective, randomized study was to examine whether additional school exercise lessons would result in improved peak oxygen uptake (primary end point) and body mass index–standard deviation score, motor and coordinative abilities, circulating progenitor cells, and high-density lipoprotein cholesterol (major secondary end points). Methods and Results— Seven sixth-grade classes (182 children, aged 11.1±0.7 years) were randomized to an intervention group (4 classes with 109 students) with daily school exercise lessons for 1 year and a control group (3 classes with 73 students) with regular school sports twice weekly. The significant effects of intervention estimated from ANCOVA adjusted for intraclass correlation were the following: increase of peak &OV0312;o2 (3.7 mL/kg per minute; 95% confidence interval, 0.3 to 7.2) and increase of circulating progenitor cells evaluated by flow cytometry (97 cells per 1×106 leukocytes; 95% confidence interval, 13 to 181). No significant difference was seen for body mass index–standard deviation score (−0.08; 95% confidence interval, −0.28 to 0.13); however, there was a trend to reduction of the prevalence of overweight and obese children in the intervention group (from 12.8% to 7.3%). No treatment effect was seen for motor and coordinative abilities (4; 95% confidence interval, −1 to 8) and high-density lipoprotein cholesterol (0.03 mmol/L; 95% confidence interval, −0.08 to 0.14). Conclusions— Regular physical activity by means of daily school exercise lessons has a significant positive effect on physical fitness (&OV0312;o2max). Furthermore, the number of circulating progenitor cells can be increased, and there is a positive trend in body mass index–standard deviation score reduction and motor ability improvement. Therefore, we conclude that primary prevention by means of increasing physical activity should start in childhood. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Identifier: NCT00176371.

Facilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device.

Background Exercise training (ET) has been shown to improve functional work capacity in patients with stable chronic heart failure (CHF) having moderate symptoms (NYHA class II). This analysis was conducted, to evaluate the effects of ET on left ventricular function and haemodynamics in patients with advanced CHF (NYHA class III) fulfilling the inclusion criteria of the COPERNICUS trial. Methods Seventy-three patients with moderate and advanced CHF were prospectively randomised to a training (n = 36), or to a control group (n = 37). At baseline and after six months, patients underwent echocardiography and symptom-limited ergospirometry with measurement of central haemodynamics by thermodilution. Results Nine out of 37 patients in the control group (C) and 10 out of 36 patients in the training group (T) had symptoms of advanced CHF. Exercise training over a period of six months resulted in an improvement of functional status on average by one NYHA class in patients with advanced CHF. Moreover, oxygen uptake at the ventilatory threshold increased by 49% (from 7.7 ± 1.0 to 11.4 ± 0.4 mL/min/kg, P<0.01 versus baseline) and at peak exercise by 32% (from 16.3 ± 1.6 to 21.5 ± 1.2 mL/min/kg, P<0.01 versus baseline) in training patients. The small, but significant reduction in left ventricular end-diastolic diameter by 7% (from 70 ± 2 to 66 ± 2 mm; P<0.05 versus baseline) was accompanied by an augmentation in stroke volume at rest by 32% (from 45 ± 3 to 60 ± 6 mL, P<0.05 versus baseline) and at peak exercise by 27% (63 ± 9 to 81 ±9 mL, P<0.05 versus baseline) as a result of ET in patients with advanced CHF. Conclusion In patients with advanced CHF (NYHA class III), long-term exercise training is associated with an enhanced physical work capacity, an improvement in stroke volume and a reduction in cardiomegaly.

Increasing physical education in high school students: effects on concentration of circulating endothelial progenitor cells

AIMS Endothelial destruction and calcification primarily occur at the aortic side of the calcified aortic valves (AVs). This study investigated whether degenerative AV stenosis (AS) is associated with the presence of valvular endothelial senescence and a reduction in the number and function of endothelial progenitor cells (EPCs). METHODS AND RESULTS Fifteen patients with severe AS and 18 age-matched control subjects were enrolled. Senescence-associated beta-galactosidase activity was mostly localized on the valvular endothelial cells (ECs) of the explanted AVs and highly coincided with the calcified lesion at the aortic side. The number (9.3 +/- 8.3 vs. 20.5 +/- 9.0 cells per 10(6) mononuclear cells; P < 0.01) and the migratory capacity (107.8 +/- 54.6 vs. 185.0 +/- 68.8 cells per 1000 cells; P < 0.01) of EPCs evaluated by FACS analysis or migration assay were significantly reduced in AS when compared with control. As possible mechanisms of alterations in EPCs, caspase-3 activity was significantly increased, whereas telomere-repeating factor-2 expression quantified by western blot was significantly reduced in EPCs from AS when compared with control. CONCLUSION Reduced regenerative capacity of valvular ECs due to senescence and decreased levels of EPCs might be, at least in part, a pathological link for the destruction of valvular ECs, resulting in progression of degenerative AS.

Midterm Results After Stentless Mitral Valve Replacement

BACKGROUND Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated. METHODS Totally endoscopic coronary artery bypass grafting on the beating heart was performed in 8 foxhound-beagle inbred dogs with the da Vinci telemanipulation system (Intuitive Surgical, Mountain View, Calif). A prototype of the endoscopic Magnetic Vascular Positioner device was used to facilitate construction of the coronary anastomosis. One pair of magnets was inserted in the internal thoracic artery and left anterior descending artery using robotic instruments to guide and place the endoscopic delivery platform. All animals underwent angiography; gross inspection of the anastomotic site was performed after excision of the hearts. RESULTS The procedure was accomplished in all animals in 169 minutes (155-190 minutes). Dissection of the left anterior descending coronary artery (6.5 minutes; 1-20 minutes), positioning of the stabilizer (8.5 minutes; 7-16 minutes), placement of occlusion tapes (6 minutes, 3-10 minutes), and arteriotomy 5.5 minutes (3-30 minutes) was achieved without problems. By use of the Magnetic Vascular Positioner device, the anastomosis at the graft site was performed with the graft still in situ. Except for 1 premature deployment, all other deployments were easily accomplished in 3 minutes (1-28 minutes). The following adverse events were encountered: bleeding from the right ventricle caused by occlusion tape (1), anastomotic leakage on reperfusion requiring repair stitches (2), and anastomotic occlusion as a result of thrombus (1). All except 1 animal with a patent graft and anastomosis survived the procedure. The overall patency was 7 of 8. DISCUSSION The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.

Delayed enhancement magnetic resonance imaging in isolated noncompaction of ventricular myocardium

Aims Levels of endothelial progenitor cells (EPCs), that can be increased by regular exercise, correlate with vascular function. In the context of primary prevention, the impact of regular physical activity on the amount and function of EPC has not yet been investigated in school children. Methods Four sixth grade classes of high school students (n = 92) were randomly assigned to either the intervention group (IG) with daily physical exercise (45 min) at school or to the control group (CG) with conventional physical education (PE) (2h/week). In addition, one sixth grade class at a high school focused on competitive sports (PE) served as a reference group. After 1 school year, exercise capacity and the amount and function of EPCs were evaluated. Results After 1 year, a significantly higher Vo2max was evident in the intervention group. Nevertheless, exercise capacity did not reach the level of children from PE. In addition, exercise intervention was successful in increasing the amount of EPCs but failed to increase the migratory capacity of the cells. Conclusion The result of this study shows, that intensified, supervised school sports leads to an increase in exercise capacity and EPCs in children. Nevertheless, its effect on primary prevention in cardiovascular disease has to be proven in further longitudinal studies. Eur J Cardiovasc Prev Rehabil 15:416-422