Background-In coronary artery disease, exercise training (ET) is associated with an improvement in endothelial function, but little is known about the relative effect of different types of training. The purpose of this study was to prospectively evaluate the effect of different types of ET on endothelial function in 209 patients after a first recent acute myocardial infarction. Methods and Results-Endothelial function was evaluated before and after 4 weeks of different types of ET and after 1 month of detraining by measuring flow-mediated dilation and von Willebrand factor levels at baseline and after ET. Patients were randomized into 4 groups: group 1, aerobic ET (nϭ52); group 2, resistance training (nϭ54); group 3, resistance plus aerobic training (nϭ53); and group 4, no training (nϭ50). At baseline, flow-mediated dilation was 4.5Ϯ2.6% in group 1, 4.01Ϯ1.6% in group 2, 4.4Ϯ4% in group 3, and 4.3Ϯ2.3% in group 4 (PϭNS). After ET, flow-mediated dilation increased to 9.9Ϯ2.5% in group 1, 10.1Ϯ2.6% in group 2, and 10.8Ϯ3% in group 3 (PϽ0.01 versus baseline for all groups); it also increased in group 4 but to a much lesser extent (to 5.1Ϯ2.5%; PϽ0.01 versus trained groups). The von Willebrand factor level after ET decreased by 16% (PϽ0.01) similarly in groups 1, 2, and 3 but remained unchanged in group 4. Detraining returned flow-mediated dilation to baseline levels (PϽ0.01 versus posttraining). Conclusion-In patients with recent acute myocardial infarction, ET was associated with improved endothelial function independently of the type of training, but this effect disappeared after 1 month of detraining.

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Background-In coronary artery disease, exercise training (ET) is associated with an improvement in endothelial function, but little is known about the relative effect of different types of training. The purpose of this study was to prospectively evaluate the effect of different types of ET on endothelial function in 209 patients after a first recent acute myocardial infarction. Methods and Results-Endothelial function was evaluated before and after 4 weeks of different types of ET and after 1 month of detraining by measuring flow-mediated dilation and von Willebrand factor levels at baseline and after ET. Patients were randomized into 4 groups: group 1, aerobic ET (nϭ52); group 2, resistance training (nϭ54); group 3, resistance plus aerobic training (nϭ53); and group 4, no training (nϭ50). At baseline, flow-mediated dilation was 4.5Ϯ2.6% in group 1, 4.01Ϯ1.6% in group 2, 4.4Ϯ4% in group 3, and 4.3Ϯ2.3% in group 4 (PϭNS). After ET, flow-mediated dilation increased to 9.9Ϯ2.5% in group 1, 10.1Ϯ2.6% in group 2, and 10.8Ϯ3% in group 3 (PϽ0.01 versus baseline for all groups); it also increased in group 4 but to a much lesser extent (to 5.1Ϯ2.5%; PϽ0.01 versus trained groups). The von Willebrand factor level after ET decreased by 16% (PϽ0.01) similarly in groups 1, 2, and 3 but remained unchanged in group 4. Detraining returned flow-mediated dilation to baseline levels (PϽ0.01 versus posttraining). Conclusion-In patients with recent acute myocardial infarction, ET was associated with improved endothelial function independently of the type of training, but this effect disappeared after 1 month of detraining.

Background: in patients with severe heart failure additional therapeutic support with intravenous inotropic or vasodilator drugs is frequently employed in an attempt to obtain hemodynamic and clinical control. No data comparing the use and efficacy of chronic intravenous inotropic and vasodilator therapy in patients with advanced heart failure are available. Aims: we evaluated, in a group of patients with advanced heart failure undergoing chronic infusion with dobutamine or nitroprus-Ž . Ž . side, in addition to optimized oral therapy, 1 the safety of chronic infusion, 2 the efficacy of both drugs in managing Ž . unloading therapy and 3 clinical outcome of the two therapeutic strategies. Methods: one hundred and thirteen patients receiving optimized oral therapy, in functional class IIIrIV with symptoms and signs of refractory heart failure and requiring additional pharmacological support with either intravenous dobutamine or nitroprusside were evaluated. Clinical and therapeutic management and clinical outcome of the two groups were considered. Results: dobutamine was administered for 12 hrday for 20 " 23 days at a dosage of 7 " 3 grkgrmin to 43 patients. The mean dose of nitroprusside was 0.76" 0.99 grkgrmin. The mean duration of use of this drug, administered as a 12-hrday infusion was 22 " 38 days. Nitroprusside Ž infusion allowed greater doses of short-term ACE-inhibitors to be used compared to pre-infusion ACE-inhibitor dose:. Ž 55 " 30 mgrday vs. 127 " 30 mgrday P-0.0001 and during dobutamine infusion ACE-inhibitor dose: 85 " 47 mgrday vs.. 127 " 30 mgrday P-0.002 . Nitroprusside unlike dobutamine significantly improved the NYHA functional class. Of the 113 Ž . patients, 109 97% had a cardiac event during a mean follow-up of 337 " 264 days. Forty-four patients required hospitaliza-Ž . Ž . tion for worsening congestive heart failure, 45r113 39% patients died during the follow-up and 27r113 24% patients had a heart transplant in status one. Hospitalization, because of worsening heart failure was less frequent in the nitroprusside than w Ž . Ž . x Ž . in the dobutamine subgroup 29r51 57% vs. 19r22 86% P-0.02 . The overall mortality was 28% 20r70 in the Ž . Ž . nitroprusside group and 58% 25r43 in the dobutamine group odds ratio 0.33 CI 0.16 to 0.73 P-0.006 . In the group Ž . treated with nitroprusside, heart transplantation in status one was performed in 16r33 patients 48% , while in the Ž . Ž . dobutamine group this was done in 11r14 patients 78% odds ratio 0.25 CI 0.06᎐1.02 P-0.06 . There was a significant reduction in the combined end-point of mortalityrheart transplantation in status one in patients treated with nitroprusside Ž Ž . Ž . Ž . compared to those treated with dobutamine 36r70 51% vs. 36r43 84% ᎏ odds ratio 0.34 CI 0.14᎐0.80 P-0.01 . The