Purpose: To evaluate the effects of cardiac rehabilitation on circulating blood markers of endothelial function: nitric oxide (NOx), Xanthine Oxidase (XO) and asymmetricdimethylarginine (ADMA), and their prognostic significance on recurrent chest pain.
Methods: 65 patients (pts) (58.82±4.25 years, all men) were admitted to cardiac rehabilitation after myocardial infarction (MI). All patients underwent a supervised 3 weeks exercise training. At baseline and after 3 weeks in all pts values of NOx, XO and ADMA were determined. Clinical long-term follow-up (5 years) was performed. All medical therapy were documented, and for this analysis, we focused on recurrent anginal chest pain.
Results: After follow-up period there were no cardiovascular (CV) hard end points (CV death, MI, stroke), however 35 pts (54%) had episodes of typical anginal chest pain (AP group) while 30 pts (46%) were without anginal chest pain (no-AP group). During rehabilitation NOx increased in both groups: in no-AP group (from 33.42±7.51 to 48.12±10.05 μmol/L, p<0.0001) and in AP group (from 34.55±6.22 to 41.10±5.15 μmol/L, p<0.001) with significantly higher second measurement in no-AP group (p=0.001). The mean NOx increase in no-AP group was higher than in AP group (14.70±8.85 vs 6.55±5.72, p<0.0001). XO levels decreased in both groups, with higher mean XO decrease in no-AP group (119.40±12.90 vs 89.30±12.85 μmol/L, p<0.001). Also, ADMA levels decreased in both groups, with higher mean ADMA decrease in no-AP group (0.07±0.05 vs 0.04±0.06 μmol/L, p=0.03). A positive correlation was found between NOx increase and XO decrease in all pts (r=0.922, p<0.001); also between NOx increase and ADMA decrease in all pts (r=0.834, p<0.001). Univaried logistic regression analyses were performed and showed that NOx increase (OR 0.792, CI 0.610 - 0.982, p<0.001), XO decrease (OR 0.812, CI 0.641–0.971, p=0.005) and ADMA decrease (OR 0.905, CI 0.829–0.974, p=0.002) significantly predict a 5 years period without anginal chest pain.
Conclusion: Residential cardiovascular rehabilitation, in patients with stable coronary artery disease, improved endothelial function. Patients with higher increase of NOx, and greater reduction in XO and ADMA values after 3 weeks of specialized cardiac rehabilitation, during 5 years follow up, were without anginal chest pain and without any CV event.