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European Journal of Heart Failure 2007 9(6-7):630-636; doi:10.1016/j.ejheart.2007.03.003
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© 2007 European Society of Cardiology

Exercise training reduces sympathetic nerve activity in heart failure patients treated with carvedilol

Raffael Fragaa, Fábio G. Francoa, Fabiana Roveda, Luciana N.J. de Matosa, Ana M.F.W. Bragaa, Maria U.P.B. Rondona, Daniel R. Rottaa, Patricia C. Brumb, Antonio C.P. Barrettoa, Holly R. Middlekauffc and Carlos E. Negrãoa,b,*

a Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil
b School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
c University of California, Los Angeles, Medical School, Department of Cardiology, USA

* Corresponding author. Instituto do Coração - (InCor), Unidade de Reabilitação Cardiovascular e Fisiologia do Exercício, Av. Dr. Enéas de Carvalho Aguiar, 44, Cerqueira César, São Paulo, SP, CEP 05403-000, Brazil. Tel: +55 11 3069 5699; fax: +55 11 3069 5043. E-mail address: cndnegrao{at}incor.usp.br


  Abstract

Background: Evidence suggests that carvedilol decreases muscle sympathetic nerve activity (MSNA) in patients with heart failure (HF) but carvedilol fails to improve forearm vascular resistance and overall functional capacity. Exercise training in HF reduces MSNA and improves forearm vascular resistance and functional capacity.

Aims: To investigate whether the beneficial effects exercise training on MSNA are maintained in the presence of carvedilol.

Methods and results: Twenty seven HF patients, NYHA Class II–III, EF <35%, peak VO2 <20 ml/kg/min, treated with carvedilol were randomly divided into two groups: exercise training (n=15) and untrained (n=12). MSNA was recorded by microneurography. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. The four-month training program consisted of three 60-min exercise/week on a cycloergometer. Baseline parameters were similar between groups. Exercise training reduced MSNA (–14±3.3 bursts/100 HB, p=0.001) and increased forearm blood flow (0.6±0.1 mL/min/100 g.p p>0.001) in HF patients on carvedilol. In addition, exercise training improved peak VO2 in HF patients (20±6%, p=0.002). MSNA, FBF and peak VO2 were unchanged in untrained HF patients on carvedilol.

Conclusion: Exercise training reduces MSNA in heart failure patients treated with carvedilol. In addition, the beneficial effects of exercise training on muscle blood flow and functional capacity are still realized in patients on carvedilol.

Key Words: Heart failure • Exercise • Autonomic control • Carvedilol

Received October 24, 2006; Revised February 1, 2007; Accepted March 7, 2007


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