{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T19:24:10Z","timestamp":1784661850247,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Cardiology","award":["2.47\/VII\/20"],"award-info":[{"award-number":["2.47\/VII\/20"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Methylated arginine metabolites interrupt nitric oxide synthesis, which can result in endothelium dysfunction and inadequate vasodilation. Since little is known about the dynamics of arginine derivatives in patients with heart failure (HF) during physical exercise, we aimed to determine this as well as its impact on the patient outcomes. Fifty-one patients with HF (left ventricle ejection fraction-LVEF \u2264 35%, mean 21.7 \u00b1 5.4%) underwent the cardiopulmonary exercise test (CPET). Plasma concentrations of L-arginine, citrulline, ornithine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) were measured before and directly after CPET. All patients were followed for a mean of 23.5 \u00b1 12.6 months. The combined endpoint was: any death, urgent heart transplantation, or urgent LVAD implantation. L-arginine concentrations increased significantly after CPET (p = 0.02), when ADMA (p = 0.01) and SDMA (p = 0.0005) decreased. The parameters of better exercise capacity were positively correlated with post-CPET concentration of L-arginine and inversely with post-CPET changes in ADMA, SDMA, and baseline and post-CPET SDMA concentrations. Baseline and post-CPET SDMA concentrations increased the risk of endpoint occurrence (HR 1.02, 95% CI 1.009\u20131.03, p = 0.04 and HR 1.02, 95% CI 1.01\u20131.03, p = 0.02, respectively). In conclusion, in patients with HF, extensive exercise is accompanied by changes in arginine derivatives that can reflect endothelium function. These observations may contribute to the explanation of the pathophysiology of exercise intolerance in HF.<\/jats:p>","DOI":"10.3390\/biom13030423","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T02:32:12Z","timestamp":1677205932000},"page":"423","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["L-arginine and Its Derivatives Correlate with Exercise Capacity in Patients with Advanced Heart Failure"],"prefix":"10.3390","volume":"13","author":[{"given":"Anna","family":"Drohomirecka","sequence":"first","affiliation":[{"name":"Department of Heart Failure and Transplantation, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4904-6398","authenticated-orcid":false,"given":"Joanna","family":"Wa\u015b","sequence":"additional","affiliation":[{"name":"Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Wilig\u00f3rska","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplantation, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz M.","family":"Rywik","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplantation, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Komuda","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplantation, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Soko\u0142owska","sequence":"additional","affiliation":[{"name":"Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3905-5872","authenticated-orcid":false,"given":"Anna","family":"Luty\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9277-0552","authenticated-orcid":false,"given":"Tomasz","family":"Zieli\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplantation, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2048004019843047","DOI":"10.1177\/2048004019843047","article-title":"Endothelial dysfunction and heart failure: A review of the existing bibliography with emphasis on flow mediated dilation","volume":"8","author":"Giannitsi","year":"2019","journal-title":"JRSM Cardiovasc. 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