Via L-arginina-óxido nítrico e insuficiência cardíaca: associação ao condicionamento físico

Abstract

Heart failure (HF) is a clinical syndrome that have high incidence and negative long-term outcome. Usually, is the final route of most of the diseases that damage the heart, and is one of the most important clinical challenges in the health area. The nitric oxide (NO) represents an important role in the regulation of vascular homeostasis. This short half-life gas is synthesized from the amino acid L-arginine by the NO synthase enzymes (NOS), leading to increased production of GMPc. A lot of studies show that abnormalities in NO bioavailability in platelets can contribute to thrombotic events, which have not yet been evaluated in HF. In the first part of the study, the aim was to investigate the effect of HF on activity and expression of NOS and content of GMPc in platelets, platelet aggregation, and anthropometric and body composition, biochemical variables, plasma amino acid, oxidative stress and the systemic concentration of inflammatory markers in 15 patients with HF and 15 healthy controls. In the second part of the study, aimed to evaluate the effects of physical training (PT) to regulate these same variables, except the expression of NOS isoforms, and including hemodynamic and respiratory. To this end, we evaluated 15 patients with HF who remained sedentary and 15 HF patients that had done 30 minutes of predominantly aerobic physical activity and localized counter-resistance muscular training with free weights and machines three times per week for 24 weeks.The results of the first stage of the study revealed the presence of platelet hyperaggregability induced by collagen as well as ADP associated with oxidative stress, and a increase in intraplatelet NOS activity, GMPc concentration and L-arginine plasma levels in patients with HF compared to healthy controls. The expression of the inducible isoform of NOS, but not endothelial isoform, was enhanced in platelets from HF patients. HF seems to induce an inflammatory response with an increase in the systemic levels of C-reactive protein, fibrinogen, inteleukin-6 and the tumour necrosis factor α. After the PT period, the HF patients had an increase in exercise time with a consequent improvement in maximum oxygen consumption (VO2). Moreover, PT leads to a reduction in total cholesterol, LDL-cholesterol and triglycerides and an increase in HDL-cholesterol. Plasma levels of L-arginine also increase after exercise. Platelet aggregation induced by both ADP and collagen were diminished by PT. Paradoxically, there was reduction of intraplatelet NO production compared to the baseline and control group after 24 weeks of exercise. In relation to oxidative stress, systemic and intraplatelet TBARs production and carbonylation were diminished in presence of an improvement of SOD and catalase activities after 24 hours of training in HF patients. Moreover, systemic levels of CRP, fibrinogen and TNF-α were reduced in CHF after training. Our results suggest that chronic exercise has anti-oxidant, anti-inflammatory and anti-aggregant effects, regardless of NO production, showing that it may be an important non-pharmacological tool in the treatment of HF