Original articles

Cardiac rehabilitation

Effect of cardiac rehabilitation on angiogenic cytokines in postinfarction patients

B-C Lee^1,2, H-C Hsu¹, W-Y I Tseng^3,4, M-Y M Su⁵, S-Y Chen⁶, Y-W Wu^1,2, K-L Chien^1,7, M-F Chen¹

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
³ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
⁴ Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan
⁵ Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
⁶ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
⁷ Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

Professor M-F Chen, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan; mfchen{at}ntu.edu.tw

Objective: To determine whether cardiac rehabilitation influences plasma levels of angiogenic cytokines and their correlation with myocardial blood flow (MBF).

Design: Randomised controlled study.

Setting: Tertiary cardiac centre.

Patients: 39 postinfarction patients randomised to either a 3-month training group (n = 20) or a non-training group (n = 19), and 19 normal controls.

Interventions: Cardiac rehabilitation.

Main outcome measures: MBF by cardiac magnetic resonance imaging, and plasma levels of stem cell factor (SCF), stromal-derived factor-1 (SDF-1), and vascular endothelial growth factor (VEGF) measured at enrolment and at 3 months after randomisation.

Results: At baseline, when compared with the healthy subjects, postinfarction patients had a lower MBF in the infarcted myocardium during dipyridamole-induced stress (1.65 (0.58) vs 2.77 (0.78) ml/min/g, p<0.001) but higher plasma levels of VEGF (3.65 (0.75) vs 2.77 (0.59) pg/ml, p<0.001 expressed as the natural logarithm) and SDF-1 (2113 (345) vs 1869 (309) pg/ml, p = 0.009). Only SDF-1 was inversely associated with stress MBF in both remote (r = –0.39, p = 0.03) and infarcted myocardium (r = –0.62, p<0.001). After 3 months, the training group’s stress MBF had increased by 33% in the remote (p<0.001) and 28% in infarcted myocardium (p = 0.02), while VEGF decreased by 9% (p = 0.01), and SDF-1 decreased by 11% (p = 0.02). The change in SDF-1 was inversely correlated with the change in stress MBF in both remote (r = –0.40, p = 0.01) and infarcted myocardium (r = –0.50, p = 0.001). In the non-training group, MBF and cytokines were unchanged.

Conclusion: Cardiac rehabilitation improves stress MBF in postinfarction patients, with an inverse decrease in circulating angiogenic cytokines.

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