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Is hormonal activation during exercise useful for risk stratification in patients with moderate congestive heart

Pascal de Groote1, Benoît Soudan, Nicolas Lamblin

  • 1TOP Service de Cardiologie C, Hôpital Cardiologique, Lille Cedex, France. pdegroote@chru-lille.fr

American Heart Journal
|August 17, 2004
PubMed

Insights

B-type natriuretic peptide (BNP) at rest, not peak exercise, predicts survival in moderate heart failure patients. Exercise levels of BNP, ANP, and norepinephrine did not improve risk stratification. BNP at rest is a key survival predictor.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Biomarkers

Background:

  • Previous research identified A-type natriuretic peptide (ANP) at peak exercise as a cardiac survival predictor.
  • No data existed on the predictive value of B-type natriuretic peptide (BNP) at peak exercise.

Purpose of the Study:

  • To investigate the predictive value of natriuretic peptides (ANP and BNP) and norepinephrine at rest and peak exercise for cardiac survival in stable congestive heart failure (CHF) patients.
  • To determine if exercise levels of these biomarkers improve risk stratification beyond established predictors.

Main Methods:

  • 150 stable CHF patients underwent echocardiography and cardiopulmonary exercise testing.
  • Plasma levels of ANP, BNP, and norepinephrine were measured at rest and peak exercise.
  • Patients were followed for a median of 1171 days for cardiac-related deaths.

Main Results:

  • Exercise significantly increased plasma levels of ANP, BNP, and norepinephrine.
  • Independent predictors of cardiac survival included percent of maximal predicted oxygen consumption, BNP at rest, and left atrial diameter.
  • Plasma levels of ANP, BNP, and norepinephrine measured at peak exercise did not improve risk stratification.

Conclusions:

  • Peak exercise levels of ANP, BNP, and norepinephrine are not independent predictors of cardiac survival in moderate CHF.
  • BNP at rest, along with maximal oxygen consumption and left atrial diameter, is an independent predictor of survival in this patient group.
  • BNP at rest offers valuable prognostic information for CHF patients with a low risk of cardiac events.
Abstract

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