RESUMEN
BACKGROUND: Radial artery catheterization is associated with endothelial denudation and impaired vasodilator function, while postcatheterization exercise training may enhance artery function. The impact of catheterization and subsequent exercise training on low-flow mediated vasoconstriction (L-FMC) has not previously been studied. The aim of this study was to examine whether radial artery L-FMC is impaired by catheterization and consequent endothelial denudation. A further aim was to examine the effect of local handgrip exercise training on radial artery L-FMC and flow-mediated dilation (FMD) after transradial catheterization. METHODS AND RESULTS: Thirty-two subjects undergoing transradial catheterization underwent assessment of L-FMC and FMD in the catheterized and contralateral radial artery before, and the day after, catheterization. A further 18 patients were recruited and randomly assigned to either a 6-week handgrip exercise training program (N=9) or a nonexercise control period (N=9). L-FMC was attenuated 1 day postcatheterization in the catheterized arm (-2.07±0.84 to 0.35±0.83), but unchanged in the noncatheterized arm (-0.93±0.86 to -0.90±0.92; P<0.05). In the training study, both FMD and L-FMC of the catheterized arm were preserved in the exercise group 7 weeks after catheterization (FMD-pre, 6.84±0.79; FMD-post, 6.85±1.16; L-FMC-pre, -2.14±1.42; L-FMC-post, -3.58±1.04%), but reduced in the control group (FMD-pre, 8.27±1.52; FMD-post, 4.66±0.70; P=0.06; L-FMC-pre, -3.26±1.19; L-FMC-post, -1.34±1.27%; P<0.05). CONCLUSIONS: Catheterization, and associated endothelial denudation, decreases L-FMC in the radial artery, suggesting that it is endothelium-dependent. Moreover, we demonstrate for the first time that exercise training has beneficial impacts on radial artery vasodilator and constrictor function.
Asunto(s)
Cateterismo Periférico/efectos adversos , Endotelio Vascular/fisiopatología , Terapia por Ejercicio , Arteria Radial/fisiopatología , Lesiones del Sistema Vascular/terapia , Vasoconstricción , Anciano , Velocidad del Flujo Sanguíneo , Endotelio Vascular/lesiones , Inglaterra , Femenino , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial/lesiones , Flujo Sanguíneo Regional , Factores de Tiempo , Resultado del Tratamiento , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/fisiopatología , VasodilataciónRESUMEN
Coronary angiography and angioplasty are common invasive procedures in cardiovascular medicine, which involve placement of a sheath inside peripheral conduit arteries. Sheath placement and catheterization can be associated with arterial thrombosis, spasm and occlusion. In this paper we review the literature pertaining to the possible benefits of arterial 'prehabilitation'--the concept that interventions aimed at enhancing arterial function and size (i.e. remodelling) should be undertaken prior to cardiac catheterization or artery harvest during bypass graft surgery. The incidence of artery spasm, occlusion and damage is lower in larger arteries with preserved endothelial function. We conclude that the beneficial effects of exercise training on both artery size and function, which are particularly evident in individuals who possess cardiovascular diseases or risk factors, infer that exercise training may reduce complication rates following catheterization and enhance the success of arteries harvested as bypass grafts. Future research efforts should focus directly on examination of the 'prehabilitation' hypothesis and the efficacy of different interventions aimed at reducing clinical complications of common interventional procedures.
Asunto(s)
Arteriopatías Oclusivas/prevención & control , Arterias/fisiología , Cateterismo Periférico/efectos adversos , Ejercicio Físico/fisiología , Trombosis/prevención & control , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Arteriopatías Oclusivas/etiología , Arterias/anatomía & histología , Angiografía Coronaria/efectos adversos , Angiografía Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Humanos , Educación y Entrenamiento Físico , Trombosis/etiologíaRESUMEN
The incidence and prevalence of heart failure are rapidly rising. Despite the improvement in pharmacologic treatment, many patients have severe persistent symptoms, and their prognosis remains poor. One of the most recent advances in heart failure management is the concept of cardiac resynchronisation therapy (CRT). This therapy aims to pace the right and left ventricles synchronously to contract simultaneously and therefore enhances cardiac output. Clinical trials on CRT have demonstrated both morbidity and mortality benefits. This article reviews the evidence for CRT, the current indications, and important information relevant to the clinician treating patients with heart failure. It also highlights some of the current controversies in this field as well as the need for future research.