Abstract

Background Cardiac rehabilitation improves myocardial blood flow (MBF) in the patients with myocardial infarction (MI), but the mechanism is unclear. Angiogenic cytokines such as stromal-derived factor-1 (SDF-1), vascular endothelial growth factor (VEGF) and stem cell factor (SCF) could recruit circulating stem cells to improve tissue perfusion. We tested the hypothesis that plasma SDF-1, VEGF or SCF levels were association with MBF in the scarred myocardium in the post-MI patients undergoing cardiac rehabilitation. Methods and Results Thirty-nine patients were recruited, and 20 were randomly assigned to undergo a training program. Nineteen age- and sex- matched healthy subjects without any cardiovascular risk factors constituted the normal group. MBF, quantified with cardiac magnetic resonance by model-independent deconvolution methods, was assessed in the scarred myocardium at rest and at stress. Compared to the healthy subjects, peak oxygen uptake (VO 2 ) and MBF at stress, but not that at rest were lower; while SDF-1 and VEGF, but not SCF were higher in the post-MI patients. After 3 months, an increased MBF at stress (+30%, P <0.01) and peak VO 2 (+15%, P =0.01) and decreased SDF-1 (−11%, P =0.01) and VEGF (−9%, P <0.01) were seen in the training group, but not the MI control or normal group. The change in peak VO 2 correlated with the changes in MBF at stress and SDF-1 and VEGF ( r =0.48, −0.38, −0.40, respectively; all P <0.05). Conclusions Cardiac rehabilitation improves myocardial blood flow in the scarred myocardium with a concomitant decrease in plasma angiogenic cytokines.

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