Endothelial function and exercise capacity in patients with chronic heart failure

我们探讨了慢性心力衰竭患者外周血管内皮细胞功能障碍的临床意义。在慢性心力衰竭患者中，运动能力与乙酰胆碱所确定的外周血管扩张功能之间存在显著的相关性(Am J心脏ol 77；98-102：1995)。此外，我们还发现心脏瓣膜病心内直视手术后患者的下肢血管储备能力得到了改善，并且发现血管功能的改变与运动能力的改变显著相关，这是由最大摄氧量决定的(提交的论文)。这些观察表明，内皮依赖的外周血管扩张能力可能在心力衰竭时调节运动诱导的血管扩张中起重要作用。我们还观察了L-精氨酸(内皮衍生一氧化氮的底物)对慢性心力衰竭患者(n=14)下肢外周血管扩张储备和运动能力的影响。尽管注射L-精氨酸显著增加了小腿反应性充血血流量，但运动能力并没有立即改善。这些结果将在一次国际医学会议(第19届欧洲心脏病学会，斯德哥尔摩，1997年)上发表。

We have investigated clinical significance of peripheral endothelial dysfunction in patients with chronic heart failure. There was a significant correlation between exercise capacity and periheral vascular dilatory function determined by acetylcholine administration in patients with chronic heart failure (Am J Cardiol 77 ; 98-102 : 1995). Furthermore, we have found an improvement of lower limb vasodilatory reserve capacity after open heart surgery for valvular heart disease, and found that changes in the vascular function were significantly correlated with changes in exercise capacity as determined by peak oxygen uptake (paper in submission). These observations suggest that endothelium-dependent peripheral vasodilatory capacity may be important in the regulation of exercise-induced vasodilation in heart failure. We have also examined effects of L-arginine (a substrate of endothelium-derived nitric oxide) on lower limb peripheral vasodilatory reserve and exercise capacity in patients with chronic heart failure (n=14). Although reactive hyperemic blood flow in the calf was significantly augmented by L-arginine infusion, exercise capacity did not improve immediately. These results will be presented in an international medical meeting (19th European Society of Cardiology, Stockholm, 1997).