Zusammenfassung
Hintergrund
Eine endotheliale Dysfunktion wird sowohl bei Patienten mit chronischer Herzinsuffizienz als auch bei Patienten mit insulinpflichtigem Diabetes mellitus gefunden. Diese Endotheldysfunktion führt zu einer deutlichen Reduktion der endothelvermittelten Vasodilatation. Körperliches Training kann einen positiven Effekt auf die gestörte Endothelfunktion bei koronarer Herzerkrankung, chronischer Herzinsuffizienz und Diabetes mellitus ausüben. Unklar ist allerdings, ob ein Trainingsprogramm auf die Endothelfunktion bei Diabetikern mit chronischer Herzinsuffizienz Einfluss hat. Somit war Ziel unserer Arbeit zu überprüfen, ob ein spezielles Trainingsprogramm Auswirkung auf die Endothelfunktion hat. Die Untersuchung wurde vergleichend bei insulinpflichtigen Typ-2-Diabetikern und Nicht-Diabetikern mit schwerer chronischer Herzinsuffizienz durchgeführt.
Methodik
42 Patienten mit schwerer chronischer Herzinsuffizienz (LVEF≤30%), insulinpflichtige Typ-2-Diabetiker (n=20, Durchschnittsalter 67±6 Jahre, 16 männlich, 4 weiblich), Nicht-Diabetiker (n=22, Durchschnittsalter 68±10 Jahre, 20 männlich, 2 weiblich) nahmen an einem vierwöchigen Trainingsprogramm bestehend aus Ergometer- und speziellem Muskelaufbautraining teil. Vor Beginn (T1) und am Ende (T2) des Trainingsprogramms wurden mittels Durchmesserbestimmung der Arteria brachialis die endothelabhängige und endothelunabhängige Vasodilatation erfasst.
Ergebnisse
Am Ende des Trainingsprogramms zeigten sich innerhalb der beiden Gruppen keine signifikanten Veränderungen. Die endothelabhängige Vasodilatation veränderte sich zwischen den Zeitpunkten T1 und T2 wie folgt: In der Gruppe der Diabetiker lag zu Beginn (T1) und am Ende (T2) die endothelabhängige Vasodilatation bei 5,1±3,6 vs. 4,9±2,5%. Für die Nicht-Diabetiker betrug die endothelabhängige Vasodilatation zu T1 und T2 6,8±4,5 vs. 7,6±4,0%. Die endothelunabhängige Vasodilatation lag bei den Diabetikern zu Beginn (T1) bei 10,5±5,6 und fiel am Ende (T2) auf 8,7±4,1% ab. Die Ergebnisse der Nicht-Diabetiker lagen für die Untersuchungszeitpunkte T1 und T2 bei 13,2±5,8 vs. 12,3±6,3%. Die LVEF betrug bei den Diabetikern zu Beginn (T1) 24,2±3,4% und nahm am Ende (T2) auf 27,8±5,8% zu. Bei den Nicht-Diabetikern lag die LVEF bei T1 22,9±3,8 vs. T2 28,6±6,9%. Zu Beginn (T1) und am Ende (T2) lag die maximale Sauerstoffaufnahme (VO2max) in der Gruppe der Diabetiker bei 10,3±3,9 vs. 11,4±2,8 ml/kg/min und in der Gruppe der Nicht-Diabetiker bei 10,0±3,1 vs. 13,5±5,0 ml/kg/min. Korrelationen zwischen der prozentualen Veränderung der endothelabhängigen Vasodilatation und der Zunahme der Sauerstoffaufnahme wurden nicht gefunden.
Schlussfolgerung
In unserer Untersuchung hatte bei insulinpflichtigen Typ-2-Diabetikern und Nicht-Diabetikern mit deutlich eingeschränkter Auswurffraktion ein Trainingsprogramm keinen Einfluss auf die endothelabhängige und -unabhängige Vasodilatation. Jedoch zeigte sich in beiden Gruppen ein trainingsabhängiger Einfluss auf medizinische Parameter und körperliche Leistungsdaten.
Summary
Background
Endothelial dysfunction is found both in patients with chronic heart failure and in patients with insulin-treated type 2 diabetes mellitus. This endothelial dysfunction leads to a significant reduction in endothelium-derived vasodilation. Physical exercise can have a positive effect on endothelial dysfunction in patients with coronary artery disease, chronic heart failure and diabetes mellitus. It is not clear, however, whether an exercise program influences endothelial function in diabetics with chronic heart failure. Our study was thus aimed at investigating whether a special exercise program would affect endothelial function. Comparisons were made with insulintreated type 2 diabetics and with non-diabetics suffering from chronic heart failure.
Methods
42 patients with severe chronic heart failure (LVEF≤30%), insulin-dependent diabetics (n=20, mean age 67±6 yrs, 16 male, 4 female), non-diabetics (n=22, mean age 68±10 yrs, 20 male, 2 female) participated in a 4-week exercise program consisting of ergometer and special muscle strength training. Before (T1) and at the end (T2) of the training program endothelium-dependent and endothelium-independent vasodilatory capacity were assessed by brachial artery diameter measurement.
Results
At the end of the training program, there were no significant results within the two groups. The endothelium-dependent vasodilation changed between T1 and T2 as follows: In the diabetic group, the endothelium-dependent vasodilation at T1 and T2 was 5.1±3.6 and 4.9±2.5%, respectively. For the non-diabetics, the endothelium-dependent vasodilation was 6.8±4.5 and 7.6±4.0% at T1 and T2, respectively. The endotheliumindependent vasodilation in the diabetics was 10.5±5.6 at T1 and dropped to 8.7±4.1% at T2. The results for the non-diabetics were 13.2±5.8 and 12.3±6.3% at T1 and T2, respectively. The LVEF in the diabetics was 24.2±3.4% at T1, increasing to 27.8±5.8% at T2. In the non-diabetics, the LVEF was 22.9±3.8 at T1 vs. 28.6±6.9% at T2. In the groups of diabetics, the maximum oxygen uptake (VO2-max) was 10.3±3.9 at T1 vs. 11.4±2.8 ml/kg/min at T2 and in the group of non-diabetics 10.0±3.1 vs. 13.5±5.0 ml/kg/min. No correlations were found between the change in endothelium-dependent vasodilation and the increase in oxygen uptake.
Conclusion
In our study, a program of physical exercise had no influence on endothelium-dependent or endothelium-independent vasodilation in insulin-treated type 2 diabetics or in non-diabetics with considerably reduced ejection fraction. In both groups, however, an exercise-related influence on medical parameters and physical performance could be observed.
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Miche, E., Herrmann, G., Nowak, M. et al. Effect of an exercise training program on endothelial dysfunction in diabetic and non-diabetic patients with severe chronic heart failure. Clin Res Cardiol 95 (Suppl 1), i117–i124 (2006). https://doi.org/10.1007/s00392-006-1106-z
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DOI: https://doi.org/10.1007/s00392-006-1106-z