Dados recentes do nosso laboratório sugerem que a enzima dipeptidil peptidase IV (DPPIV), uma serino-protease que pode ser encontrada ancorada na membrana celular de diversos tipos celulares ou na forma solúvel no plasma, possui um papel importante na fisiopatologia da insuficiência cardíaca (IC). Mais especificamente, demonstramos que a atividade da DPPIV circulante está associada com piores desfechos cardiovasculares em modelo experimental e pacientes com IC. Ademais, observamos que a inibição crônica da DPPIV atenua o desenvolvimento e/ou a progressão da IC em ratos submetidos à injúria do miocárdio. Entretanto, não é sabido se a inibição desta peptidase é capaz de reverter a disfunção cardiorrenal em ratos com IC estabelecida. Assim, este trabalho teve como objetivo testar a hipótese que a inibição da DPPIV exerce efeitos terapêuticos em ratos com IC. Para tal, ratos com IC foram tratados diariamente com o inibidor da DPPIV Vildagliptina (80 ou 120 mg/kg/dia) ou veículo (HF) durante quatro semanas. Ratos Sham não-tratados foram utilizados como controle. Análises ecocardiográficas demonstraram que ratos HF exibiram área fracional (FAC) menor e tempo de relaxamento isovolumétrico (TRIV) maior que ratos Sham. Por sua vez, o tratamento com a dose maior de Vildagliptina foi capaz de aumentar a FAC e diminuir o TRIV. Esta melhora funcional foi acompanhada por melhoras estruturais, visto que a inibição da DPPIV foi capaz de reduzir a hipertrofia cardíaca e a deposição de colágeno intersticial no miocárdio remanescente de ratos tratados com Vildagliptina em comparação aos ratos HF. Adicionalmente, ratos com IC exibiram maior teor de água nos pulmões, menor excreção urinária de sódio, menor fluxo urinário e menor ritmo de filtração glomerular em comparação ao grupo Sham. Por sua vez, o manuseio renal de sal e água foi completamente restaurado pelo tratamento crônico com 120 mg/kg/dia Vildagliptina. A normalização da função renal induzida pela inibição crônica da DPPIV foi associada com um aumento da expressão do receptor do peptídeo-1 semelhante ao glucagon (GLP-1) e maior ativação da proteína cinase A em córtex renal, isto é, da via de sinalização deflagrada pela ligação GLP-1/GLP-1R. Além disso, os níveis pós-prandiais do GLP-1, principal substrato da DPPIV que exerce ações insulinotrópicas, cardio e renoprotetoras, estavam mais baixos em ratos HF que em ratos Sham. Esta diminuição dos níveis circulantes de GLP-1 (ativo e total) em ratos HF foi acompanhada de intolerância à glicose bem como de maiores níveis plasmáticos de insulina. A inibição da DPPIV com Vildagliptina melhorou a biodisponibilidade e a secreção de GLP-1 após carga oral de glicose. Em conjunto, estes resultados sugerem que a inibição da DPPIV melhora a função cardiorrenal e metabólica de ratos com IC. Além disso, a secreção e a biodisponibilidade do GLP-1 encontram-se prejudicadas em ratos com IC e o tratamento com Vildagliptina é capaz de restaurar a sinalização mediada por este peptídeo. Assim, os inibidores da DPPIV podem ser eficazes não apenas para a prevenção, mas também para o tratamento da insuficiência cardíaca em ratos / Recent data from our laboratory suggest that the enzyme dipeptidyl peptidase IV (DPPIV), a serine protease that can be found anchored in the cell membrane of different cell types or in the soluble form in plasma, plays an important role in the pathophysiology of heart failure (HF). More specifically, we have demonstrated that the activity of circulating DPPIV is associated with poorer cardiovascular outcomes in an experimental model and patients with HF. In addition, we have found that chronic inhibition of DPPIV attenuates the development and/or progression of HF in rats with myocardial injury. However, it is unknown whether the inhibition of this peptidase is able to reverse the cardiorenal dysfunction in rats with established HF. Therefore, this study aimed to test the hypothesis that inhibition of DPPIV exerts therapeutic effects in rats with HF. To this end, HF rats were treated daily with the DPPIV inhibitor vildagliptin (80 or 120 mg/kg/day) or vehicle (HF) for four weeks. Untreated Sham rats were used as controls. Echocardiographic analysis demonstrated that HF rats exhibit lower fractional area change (FAC) and higher isovolumetric relaxation time (IVRT) than Sham rats. On the other hand, treatment with the highest dose of vildagliptin was able to increase FAC and decrease IVRT. These functional improvements were accompanied by structural improvements, since inhibition of DPPIV was also able to reduce cardiac hypertrophy and interstitial collagen deposition in the remaining myocardium of rats treated with vildagliptin rats compared to HF. In addition, HF rats exhibited higher water content in the lungs, lower urinary sodium excretion, lower urinary flow and lower glomerular filtration rate compared to the Sham group. In turn, the renal handling of salt and water was completely restored by chronic treatment with vildagliptin 120 mg/kg/day. Normalization of the renal function induced by chronic inhibition of DPPIV was associated with an increase in the expression of the glucagon like peptide-1 receptor (GLP-1R) and enhanced protein kinase A activation in the renal cortex, the signaling pathway triggered by bind between GLP-1/GLP-1R. In addition, the postprandial levels of GLP-1, the main substrate of DPPIV that exerts insulinotropic, cardio and renoprotective actions, were lower in HF rats than in Sham. This decrease in circulating levels of GLP-1 (active and total) in HF rats was accompanied by impaired glucose tolerance and higher plasma insulin levels. The inhibition of the DPPIV with vildagliptin improved the bioavailability and secretion after an oral glucose load. Taken together, these results suggest that the inhibition of DPPIV ameliorates the cardiorenal and metabolic function of rats with HF. Furthermore, bioavailability and secretion of GLP-1 are impaired in HF rats and vildagliptin is able to restore the signaling mediated by this peptide. Therefore, DPPIV inhibitors can be effective not only in preventing but also for the treatment of HF in rats

No description available.

The aim was to investigate associations of fitness and types and levels of physical activity with subsequent risk of cardiovascular disease. Four large-scale longitudinal cohort studies were used. The exposures were different measures related to physical activity and the outcomes were obtained through linkage to the Swedish In-Patient Register. In a cohort of 466 elderly men without pre-existing cardiovascular disease, we found that skeletal muscle morphology was associated with risk of cardiovascular events. A high amount of type I (slow-twitch, oxidative) skeletal muscle fibres was associated with lower risk of cardiovascular events and high amount of type IIx was associated with higher risk of cardiovascular events. This association was only seen among physically active men. Among 39,805 participants in a fundraising event, higher levels of both total and leisure time physical activity were associated with lower risk of heart failure. The associations were strongest for leisure time physical activity. In a cohort of 53,755 participants in the 90 km skiing event Vasaloppet, a higher number of completed races was associated with higher risk of atrial fibrillation and a higher risk of bradyarrhythmias. Further, better relative performance was associated with a higher risk of bradyarrhythmias. Among 1,26 million Swedish 18-year-old men, exercise capacity and muscle strength were independently associated with lower risk of vascular disease. The associations were seen across a range of major vascular disease events (ischemic heart disease, heart failure, stroke and cardiovascular death). Further, high exercise capacity was associated with higher risk of atrial fibrillation and a U-shaped association with bradyarrhythmias was found. Higher muscle strength was associated with lower risk of bradyarrhythmias and lower risk of ventricular arrhythmias. These findings suggest a higher rate of atrial fibrillation with higher levels of physical activity. The higher risk of atrial fibrillation does not appear to lead to a higher risk of stroke. In contrast, we found a strong inverse association of higher exercise capacity and muscle strength with vascular disease. Further, high exercise capacity and muscle strength are related to lower risk of cardiovascular death, including arrhythmia deaths. From a population perspective, the total impact of physical activity on cardiovascular disease is positive.

No description available.

L’insuffisance cardiaque chronique est une maladie systémique où des dysfonctions périphériques viennent s’ajouter à l’incapacité du cœur à assurer un débit cardiaque adéquat aux tissus métabolisants. Parmi des dysfonctions périphériques, l’atrophie ainsi que la perte de force et d’endurance musculaire jouent un rôle primordial et contribuent largement à la genèse des symptômes majeurs de l’insuffisance cardiaque chronique, c’est à dire la fatigue, la dyspnée et l’intolérance à l’effort.<p>Ce n’est que depuis le début des années 1990 que des études ont montré que le réentraînement à l’effort pouvait être bénéfique pour le patient insuffisant cardiaque chronique; auparavant, il était considéré comme contre-indiqué.<p>La méthodologie d’entraînement proposée à cette époque aux patients était un entraînement de l’endurance cardio-vasculaire, le renforcement musculaire n’y avait pas sa place car on craignait que l’impact hémodynamique de ce type d’entraînement risquerait de détériorer la fonction cardiaque encore plus. Des études menées sur des contractions musculaires de type isométrique montraient en effet une diminution de la fonction cardiaque pendant l’entraînement. Cependant, les contraintes imposées pendant les exercices de renforcement musculaire dynamique (encore appelés « résistifs ») ne correspondent nullement à celles du renforcement isométrique. Des études sur des personnes saines ont montré que le renforcement musculaire est plus adapté à induire des améliorations du volume et de la force musculaire que l’entraînement de l’endurance cardio-vasculaire.<p>Le but de nos travaux a donc été de vérifier si l’introduction du renforcement musculaire, en complément de l’entraînement cardio-vasculaire ou bien comme entraînement à part entière, pouvait apporter un bénéfice supplémentaire chez l’insuffisant cardiaque chronique par son aptitude, du moins théorique, à mieux corriger certains aspects des dysfonctions musculaires.<p><p><p>Il s’agissait, dans les différentes études que nous avons menées, de vérifier qu’un entraînement composé de renforcement musculaire (au moins partiellement) chez le patient insuffisant cardiaque chronique:<p>-\ / Doctorat en Sciences de la motricité / info:eu-repo/semantics/nonPublished

Foi avaliada a incidência de potencial tardio pelo eletrocardiograma de alta resolução no domínio do tempo em portadores de insuficiência cardíaca congestiva de diferentes etiologias com o objetivo de se estudarem as correlações clínicas e prognósticas entre pacientes com potencial tardio presente e ausente na referida patologia. Foram estudados 288 pacientes com insuficiência cardíaca congestiva, de idades entre 16 a 70 anos (média 51,51; desvio padrão 11,24), 215 do sexo masculino (74,65%) e 73 do sexo feminino (25,35%). As etiologias da insuficiência cardíaca congestiva foram: a cardiopatia hipertensiva em 78 pacientes (27,08%); a cardiopatia isquêmica em 65 (22,57%); a Doença de Chagas em 42 (14,58%); a valvopatia em 12 (4,17%); a cardiomiopatia alcoólica em 9 (3,13%); a cardiomiopatia periparto em 6 (2,08%); a miocardite viral em 3 (1,04%). Em 73 pacientes (25,35%), a etiologia não foi identificada e a cardiomiopatia dilatada foi considerada idiopática. Foram estudados a idade, o sexo, a etiologia da insuficiência cardíaca, as variáveis do eletrocardiograma (área eletricamente inativa e bloqueios de ramo), do ecocardiograma transtorácico (diâmetro do átrio esquerdo, diâmetro sistólico e diastólico do ventrículo esquerdo), da ergoespirometria (consumo máximo de oxigênio) e do eletrocardiograma de longa duração (taquicardia ventricular não sustentada e taquicardia ventricular sustentada). No eletrocardiograma de alta resolução, foram estudadas a duração do QRS standard, a duração do QRS filtrado, a duração do sinal abaixo de 40µV e a voltagem da raiz quadrada dos últimos 40ms. Foi considerado o potencial tardio presente na vigência de dois ou mais dos seguintes critérios: Duração do QRS filtrado >= 114ms; duração do sinal abaixo de 40µV >= 38ms; voltagem da raiz quadrada dos últimos 40ms <= 20µV. Para a análise estatística, foram empregados: o teste de Fisher, para o caso de comparações entre duas variáveis categóricas com 2 categorias cada uma; o teste t-Student, para o caso de comparações entre as médias dos dois grupos para variáveis contínuas; o teste de Man-Whitney (não paramétrico), para o caso de comparações entre os dois grupos quando as variáveis eram provenientes de contagens (número de ocorrências); ANOVA (análise de variância), para o caso de comparações entre mais de dois grupos no caso de variáveis contínuas. Não se observou correlação estatística entre a presença de potencial tardio e as etiologias que levaram à insuficiência cardíaca. Houve correlação entre a duração do QRS standard e a duração do QRS filtrado com a Doença de Chagas e a cardiomiopatia dilatada idiopática. O potencial tardio mostrou correlação significativa com: bloqueios de ramo, duração do QRS maior ou igual a 120ms, consumo máximo de oxigênio, taquicardia ventricular não sustentada, taquicardia ventricular sustentada, morte súbita e mortalidade total. Ao correlacionarmos a presença de potencial tardio com uma má evolução (taquicardia ventricular sustentada, morte súbita e morte por evolução da insuficiência cardíaca) e uma boa evolução (nenhuma das complicações anteriores), foi encontrado diferença significativa no grupo que apresentava potencial tardio presente. Concluímos que pacientes com insuficiência cardíaca congestiva e portadores de potencial tardio presente ao eletrocardiograma de alta resolução têm achado estatisticamente significativo quanto à taquicardia ventricular sustentada e à morte súbita e uma má evolução em relação aos pacientes com potencial tardio ausente. / The incidence of late potential was evaluated by the signal-averaged electrocardiogram in the time domain in patients with congestive heart failure of different etiologies with the goal of studying the clinical and prognostic correlation among patients with the presence and the absence of late potential in the related pathology. 288 patients with congestive heart failure were studied, from 16 to 70 years old (average 51,51; standard deviation 11,24), 215 of males (74.65%) and 73 of females (25.35%). The etiologies of the congestive heart failure were: the hypertensive cardiomyopathy in 78 patients (27.08%); the ischemic cardiomyopathy in 65 (22.57%); the Chagas disease in 42 (14.58%); the valvopathy in 12 (4.17%); the alcoholic heart disease in 9 (3.13%); the delivery cardiomyopathy in 6 (2.08%); the viral myocarditis in 3 (1.04%). In 73 patients (25.35%); the etiology was not identified and the dilated cardiomyopathy was considered idiopathic. The age, sex, and etiology of the cardiac failure, the variable of the electrocardiogram (electric inactive area and bundle branch block), of the transthoracic echocardiogram (left atrium diameter, systolic and diastolic diameter of the left ventricle), of the cardiopulmonary exercise test (maximum consumption of oxygen) and of the Holter monitoring (nonsustained ventricular tachycardia and ventricular tachycardia) have been studied. In the signal-averaged electrocardiogram, the standard QRS duration, the filtered QRS duration, the filtered QRS complex below 40µV and the root mean square voltage of the terminal 40ms were studied. The late potential was considered in the existance of two or more of the following criteria: the filtered QRS duration >= 114ms; the filtered QRS complex bellow 40µV >= 38ms; the root mean square voltage of the terminal 40ms <= 20µV. For the statistic analysis, the Fisher test was used for the case of comparison between two specific variables, each one with 2 categories; the test t-Student was used for the case of comparison between the average of the two groups for continuous variables; the Man-Whitney test, for the case of comparison between the two groups when the variables were proceeding from counting (number of occurrences); the ANOVA (variance analysis), for the case of contrast between more than two groups in the case of continuous variables. Statistic correlation was not observed in the presence of late potential and the etiologies that had to the heart failure. There was correlation between the standard QRS duration and the filtered QRS duration with the Chagas disease and the idiopathic dilated cardiomyopathy. The late potential showed remarkable correlation with bundle branch block, duration of the largest or equal to 120ms QRS, maximum consumption of oxygen, nonsustained ventricular tachycardia, sustained ventricular tachycardia, sudden death and total mortality. When correlating the presence of late potential with a bad evolution (sustained ventricular tachycardia, sudden death and death by evolution of the heart failure) and a good evolution (none of the previous complications), relevant difference was found in the group that presented late potential. To conclude, patients with congestive heart failure and carrying late potential shown by the signal-averaged electrocardiogram have statistically relevant findings in the sustained ventricular tachycardia and the sudden death and a bad evolution in relation to the patients with absent late potential.

No description available.

No description available.

Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity. The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity. Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home. Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity. More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming. The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming. Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy. Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity. / Achtergrond: Het aantal patiënten met hartfalen (HF) dat zich kan houden aan de aanbevolen lichamelijke activiteit is over het algemeen klein. Het is essentieel om te onderzoeken in hoeverre en waarom patiënten met HF lichamelijk actief zijn. Het hebben van self-efficacy (een persoonlijke overtuiging dat hij/zij capabel is om te doen wat nodig is om een taak te volbrengen op een bepaald kwaliteitsniveau) en motivatie voor lichamelijke activiteit is belangrijk om meer lichamelijk actief te worden. Het is echter niet duidelijk wat de rol van self-efficacy is in relatie tot motivatie en lichamelijke activiteit bij patiënten met HF. Alternatieve benaderingen zijn nodig om patiënten te motiveren lichamelijk actiever te zijn en de self-efficacy te verhogen. Een van de mogelijke alternatieven om patiënten met HF te helpen lichamelijk actiever te zijn is de inzet van exergames: computerspellen om fysieke activiteit te bevorderen. Er is tot nu toe geen onderzoek is gedaan naar de inzet van exergaming bij patiënten met hartfalen en de mogelijkheden van exergaming om patiënten te stimuleren tot meer lichamelijke activiteit. Het doel van dit proefschrift is het beschrijven van de lichamelijke activiteit van patiënten met HF met extra aandacht voor de motivatie en self-efficacy ten opzichte van lichamelijke activiteit. Een tweede doel is om inzicht te krijgen in de mogelijkheid om exergaming te gebruiken om de lichamelijke activiteit van patiënten met HF te verhogen. Methode: In dit proefschrift worden gegevens van 4 studies beschreven (studie I-IV). Studie I (n = 154) en II (n = 101) hebben een crosssectioneel survey design. Studie III (n = 32) is een 12 weken durende pilot-interventie studie met een pretest-posttest design waarbij patiënten 12 weken lang een exergame platform thuis konden gebruiken. Studie IV (n = 14) beschrijft de ervaringen van patiënten die deelnamen aan de interventiegroep van een gerandomiseerde studie waarin zij een exergame platform thuis kregen. Resultaten: In totaal hebben 34% van alle patiënten met hartfalen een laag niveau van lichamelijke activiteit, 46% had een matig niveau, en 23% een hoog niveau. Een hoger opleidingsniveau, self-efficacy en motivatie significant werd geassocieerd met een hogere hoeveelheid lichamelijke activiteit. Het bleek dat barrières voor fysieke activiteit moeilijk te overbruggen waren. Met betrekking tot motivatie, bleek dat psychologische motivatie de belangrijkste drijfveer was om fysiek actief te zijn. Verder bleek dat vrouwen een significant hogere motivatie voor fysieke activiteit hebben dan mannen. Een ander belangrijk resultaat was dat self-efficacy de relatie tussen motivatie en lichamelijke activiteit beïnvloedt; motivatie leidt tot een hogere self-efficacy wat leidt tot hogere fysieke activiteit. Met betrekking tot de resultaten van exergaming bleek dat de inspanningscapaciteit van meer dan de helft van de patiënten aanzienlijk was toegenomen na 12 weken gebruik gemaakt te hebben van een exergame platform thuis. Patiënten met een lager NYHA-klasse en een kortere tijd na de diagnose verhogen significant meer hun inspanningscapaciteit. Ook bleek dat het hebben van een partner en kleinkinderen gerelateerd is aan meer tijd besteden aan exergaming. De analyse van de ervaringen van patiënten in de kwalitatieve studie resulteerde in drie categorieën: (i) zorgen dat exergaming werkt, (ii) toegevoegde waarde van exergaming, (iii) geen aantrekking tot exergaming. Conclusie: Een derde van de patiënten met HF heeft een laag niveau van lichamelijke activiteit in hun dagelijks leven. Opleidingsniveau, self-efficacy en motivatie zijn belangrijke factoren om rekening mee te houden bij het geven van advies aan patiënten met HF betreffende fysieke activiteit. Naast een hoge motivatie tot bewegen is het belangrijk dat patiënten met HF een hoog niveau van self-efficacy hebben om fysiek actief te zijn. Exergaming heeft potentie om inspanningscapaciteit bij patiënten met HF te verhogen. Uit de resultaten blijkt ook dat deze techniek geschikt is voor een deel van de patiënten, terwijl een deel van de patiënten wellicht liever andere vormen van lichamelijke activiteit beoefenen.

Die chronische Herzinsuffizienz ist ein schwerwiegendes progredientes Krankheitsbild, das sich neben Dyspnoe und abnehmender Leistungsfähigkeit in einer nachgewiesenen Verschlechterung der HDL-Funktion manifestiert. In zahlreichen Studien, in denen der Einfluss von körperlichem Training auf die Progredienz der chronischen Herzinsuffizienz untersucht wurde, korrelierte dauerhaftes Ausdauertraining mit einer Verbesserung der eNOS-Aktivität und damit der HDLFunktion in Gefäßen. Ein Regulationsmechanismus von Endothelzellen besteht in der Expression von angiogenen microRNAs, die über negative Regulation die Proteinexpression beeinflussen. Ziel dieser Studie ist es nun, einen möglichen Zusammenhang zwischen der HDL-Funktionalität und der microRNA-Expression in Endothelzellen zu prüfen und damit die Funktionsänderung von HDL bei Herzinsuffizienten auf molekularer Ebene nachzuweisen. Zudem soll eine Beeinflussung der HDL-Funktion durch körperliches Training geprüft werden. Dafür wurde das HDL von gesunden und herzinsuffizienten Probanden (NYHAIII-Stadium) vor und nach einem vier- bzw. zwölfwöchigen Trainingsprogramm aus dem Plasma isoliert. Anschließend erfolgte mit dem gewonnenen HDL die 24-stündige Inkubation von HAEC-Kulturen. Nach Isolation der microRNAs aus dem gewonnenen Zelllysat konnte die Menge ausgewählter proangiogener miRs über RT-PCR quantifiziert werden. Die molekularbiologische Analyse der Proben zeigte eine, im Vergleich zu den Kontrollzellen, signifikant verringerte Menge an miR-21, -126 und -222 in den, mit HDLNYHAIII-inkubierten, Endothelzellen. Die miR-Expression der Endothelzellen zeigte nach dem Trainingsprogramm eine Annäherung an das Expressionsniveau der Kontrollen. Aus der dargelegten Studie wird so ersichtlich, dass das HDL von Herzinsuffizienten die Expression von proangiogenen microRNAs in Endothelzellen hemmt, was scheinbar in Korrelation mit der Ausbildung von endothelialen Dysfunktionen bei Herzinsuffizienz steht. Zudem konnte gezeigt werden, dass körperliches Training mit einer verbesserten Endothelfunktion über die Erhöhung der miR-Expression in Endothelzellen einhergeht.