Brain natriuretic peptide kinetics during dynamic exercise in patients with chronic heart failure
Section snippets
Patients
The study population consisted of 37 consecutive patients, who were evaluated for CHF or heart transplantation. CHF was confirmed by left ventricular dysfunction (left ventricular ejection fraction <35%). All patients were in a clinically stable condition for at least 6 weeks and showed no signs of acute cardiac decompensation. Optimized medical CHF therapy including ACE inhibitors and β-blockers was unchanged for at least 6 weeks. CHF was confirmed by left ventricular dysfunction (left
Results
Thirty-seven patients with CHF were included in the study (Table 1). CHF was caused by idiopathic dilated cardiomyopathy in 19 patients and in 18 patients by coronary artery disease. ACE inhibitors and diuretics were administered in 92% of all patients, digitalis in 78% and β-blockers in 86%.
Significant coronary stenosis was ruled out by cardiac catheterization in all controls (Table 1). There were no wall motion abnormalities and LVEF was normal. CHF patients and controls showed no significant
Discussion
In our study, we found that vigorous exercise leads to only minor changes in BNP levels. This could be explained by the fact that BNP is synthesized in bursts and not contained in larger amounts in storage granules as opposed to atrial natriuretic peptide [14]. Recently, Mc Nairy et al. [15] demonstrated for the first time that BNP levels are not significantly altered by exercise, which makes BNP a useful tool in an outpatient setting. In his study, prior activity did not lead to marked changes
Limitations
There are some limitations of our study. We did not study the influence of medications on BNP. All patients were treated according to CHF guidelines. Previous studies demonstrated that BNP levels are reduced after treatment with β-blockers [20], whereas they are increased after treatment with ACE-inhibitors [21] or digitalis [22]. Although our study group consisted of only 37 patients with CHF, the study sample size is the largest compared to other studies investigating BNP response to exercise
Conclusions
In this study, we found that BNP levels in CHF patients and healthy controls are not significantly altered by vigorous exercise. In contrast to healthy controls, 16% of CHF patients showed a decrease in BNP levels at exercise. These patients with decreasing BNP were older and in a higher NYHA class, but their mortality was lower compared to those with increasing BNP levels. In CHF, BNP levels are inversely correlated with peak VO2, VO2-AT and LVEF. The best correlations of exercise variables
References (22)
- et al.
Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations
Lancet
(2000) - et al.
A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study
J. Am. Coll. Cardiol.
(2001) - et al.
Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent care setting
J. Am. Coll. Cardiol.
(2001) - et al.
Brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure
J. Am. Coll. Cardiol.
(2002) - et al.
Relationship between natriuretic peptides and hemodynamics in patients with heart failure at rest and after ergometric exercise
Clin. Chim. Acta
(1999) - et al.
Effects of exercise on plasma level of brain natriuretic peptide in congestive heart failure with and without left ventricular dysfunction
Am. Heart J.
(1995) - et al.
Comparison of different echocardiographic methods with radionuclide imaging for measuring left ventricular ejection fraction during acute myocardial infarction treated by thrombolytic therapy
Am. J. Cardiol.
(1998) - et al.
Stability of B-type natriuretic peptide levels during exercise in patients with congestive heart failure: implications for outpatient monitoring with B-type natriuretic peptide
Am. Heart J.
(2002) - et al.
Role of endopeptidase-24.11 in the inactivation of atrial natriuretic peptide
FEBS Lett.
(1988) - et al.
Plasma brain natriuretic peptide as a novel therapeutic indicator in idiopathic dilated cardiomyopathy during β-blocker therapy: a potential of hormone-guided treatment
Am. Heart J.
(2001)
Digitalis increases brain natriuretic peptide in patients with severe congestive heart failure
Am. Heart J.
Cited by (27)
Acute Responses to Intermittent and Continuous Exercise in Heart Failure Patients
2013, Canadian Journal of CardiologyCitation Excerpt :Furthermore, BNP, an important biomarker of ventricular mechanical stress and prognosis in relation to the severity of ventricular dysfunction,31 did not increase after HIIE or MICE. These results are consistent with previous data showing the lack of effect of a single maximal exercise on BNP.32-34 Finally, with respect to CRP, conflicting data exist on the impact of exercise on this biomarker.
Plasma ANP and BNP during exercise in patients with major depressive disorder and in healthy controls
2011, Journal of Affective DisordersUsefulness of N-Terminal Pro-B-Type Natriuretic Peptide Increase With Exercise for Predicting Cardiovascular Mortality in Patients With Heart Failure
2008, American Journal of CardiologyCitation Excerpt :McNairy et al11 showed increases in serum BNP levels of 50%, 30%, and 18% in a healthy population, patients in NYHA class I or II, and patients in NYHA class III or IV, respectively. In another study, a nonsignificant increase in BNP was found, and a decrease in serum BNP level in 15% of patients was observed.17 Kjaer et al18 reported a 30% increase in BNP levels in patients but no change in healthy subjects.
Outpatient Monitoring and Treatment of Chronic Heart Failure Guided by Amino-Terminal Pro-B-Type Natriuretic Peptide Measurement
2008, American Journal of CardiologyCitation Excerpt :Because there were significant differences in the stages of HF in the studies comparing the effects of β-blockers, these findings may be more attributable to different responses in NT-proBNP at different stages of HF, rather than heterogeneity in response to different agents. Exercise therapy has beneficial effects in chronic HF, and adequate cardiopulmonary training has been shown to decrease levels of NPs in a clinically relevant manner.27–30 Changes in NT-proBNP levels with cardiac resynchronization therapy (CRT) were assessed in the Cardiac Resynchronization in Heart Failure (CARE-HF) study.31
Relation of B-Type Natriuretic Peptide Levels Before and After Exercise and Functional Capacity in Patients With Idiopathic Dilated Cardiomyopathy
2007, American Journal of CardiologyCitation Excerpt :In patients with IDC, the clinical significance of BNP response to exercise has not been well established until now. In healthy subjects, some investigators found an increase after effort,9–11 whereas others did not.12–14 The small size of these healthy populations (10 to 33 patients) and low BNP levels seem to be the cause of this variability.