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Eur J Prev Cardiol. 2016 Jan;23(2):129-36. doi: 10.1177/2047487314565739. Epub 2014 Dec 18.

Cardiac rehabilitation improves coronary endothelial function in patients with heart failure due to dilated cardiomyopathy: A positron emission tomography study.

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Department of Cardiology, CHU de Caen, France Normandie Université, Caen, France.
Department of Cardiac Surgery, CHU de Caen, France.
Turku PET Centre, University of Turku, Finland IM Sechenov Institute of Evolutionary Physiology and Biochemistry, Russia Faculty of Medicine, Saint Petersburg State University, Russia.
Department of Biostatistic and Clinical Research, CHU de Caen, France.
Turku PET Centre, University of Turku, Finland.
Inserm U1077, Caen, France.
Cyceron PET Centre, Caen, France.
Normandie Université, Caen, France Department of Nuclear Medicine, CHU de Caen, France.
Normandie Université, Caen, France Cyceron PET Centre, Caen, France Department of Nuclear Medicine, CHU de Caen, France



Endothelial dysfunction is common in patients with heart failure and is associated with poor clinical outcome. Cardiac rehabilitation is able to enhance peripheral endothelial function but its impact on coronary vasomotion remains unknown. We aimed to evaluate the effect of cardiac rehabilitation on coronary vasomotion in patients with heart failure.


We prospectively enrolled 29 clinically stable heart failure patients from non-ischaemic dilated cardiomyopathy and without coronary risk factors. Myocardial blood flow was quantified using (15)-O water positron emission tomography at rest and during a cold pressor test, before and after 12 weeks of cardiac rehabilitation and optimization of medical therapy.


Rest myocardial blood flow was significantly improved after the completion of rehabilitation compared to baseline (1.31 ± 0.38 mL/min/g vs. 1.16 ± 0.41 mL/min/g, p = 0.04). The endothelium-related change in myocardial blood flow from rest to cold pressor test and the percentage of myocardial blood flow increase during the cold pressor test were both significantly improved after cardiac rehabilitation (respectively from -0.03 ± 0.22 mL/min/g to 0.19 ± 0.22 mL/min/g, p < 0.001 and from 101.5 ± 16.5% to 118.3 ± 24.4%, p < 0.001). Left ventricular ejection fraction, plasma levels of brain natriuretic peptide, maximal oxygen consumption and the Minnesota Living with Heart Failure Questionnaire score were also significantly improved. The improvement was not related to uptitration of medical therapy.


Coronary endothelial function is altered in patients with heart failure due to non-ischaemic dilated cardiomyopathy. In these patients, cardiac rehabilitation significantly improves coronary vasomotion.


Dilated cardiomyopathy; coronary endothelial dysfunction; heart failure; positron emission tomography; rehabilitation

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