Objective: To evaluate the effects of cardiac rehabilitation on endothelial function parameters (nitric oxide - (NOx), asymmetric-dimethylarginine (ADMA) and advanced oxidative protein products (AOPP), and their prognostic significance on recurrent chest pain in patients (pts) with stable coronary artery disease (CAD).
Design and method: 40 pts with stable CAD (55.68±8.24 years, 37 men), admitted at residential rehabilitation center, were studied. All patients underwent a 3 weeks supervised comprehensive rehabilitation program. At baseline and after 3 weeks in all pts values of NOx, ADMA and AOPP were determined. Clinical long-term follow-up (18 months) was performed. All medical therapy was documented, and this analysis was focused on recurrent chest pain during follow up period.
Results: After 18 months there were no cardiovascular (CV) hard end points (CV death, MI or stroke), but 18 pts (45%) had episodes of typical anginal chest pain (AP group) and 22 pts (55%) were without (no-AP group). During rehabilitation NOx increased in both groups: in no-AP group (from 35.86±8.99 to 47.86±13.85 μmol/L, p < 0.0005) and in AP group (from 33.63±6.41 to 38.95±9.28 μmol/L, ns) with significantly higher second measurements in no-AP group (p = 0.016). ADMA levels were decreased in both groups: no-AP group (p = 0.011) and AP group (ns). AOPP also decreased in both groups: in no-AP group (from 321.96±27.92 to 294.96±13.84 μmol/L, p < 0.0005) and in AP group (from 300.21±17.46 to 284.13±52.95 μmol/L, ns). Univaried logistic regression analyses showed that only second NOx values are significantly connected to appearance of anginal chest pain (OR 0.931, CI 0.870 - 0.996, p = 0.037).
Conclusion: In pts with stable coronary artery disease 3 weeks of supervised rehabilitation program induced improvement in endothelial function. Patients without anginal chest pain during follow up period of 18 months, had higher increase of NOx, and greater reduction in ADMA and AOPP values after 3 weeks of rehabilitation. Among other endothelial parameters, NOx was proven to be an independent predictor of recurrent anginal chest pain.