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Published on: October 1, 2019
C-type natriuretic peptide expression in patients with chronic heart failure: effects of aerobic training
Claudio Passino1, Silvia Del Ry, Silvia Severino
1Cardiovascular Medicine Department, CNR Institute of Clinical Physiology, Pisa, Italy. passino@ifc.cnr.it
Insights
Aerobic exercise training in heart failure (HF) patients improves physical function and reduces C-type natriuretic peptide (CNP) and B-type natriuretic peptide (BNP) levels, suggesting enhanced endothelial function.
Area of Science:
- Cardiology
- Exercise Physiology
- Endocrinology
Background:
- C-type natriuretic peptide (CNP) is an endothelium-derived hyperpolarizing factor.
- Endothelial dysfunction is prevalent in chronic heart failure (HF).
- Physical training can positively impact endothelial function in HF patients.
Purpose of the Study:
- To investigate the effect of aerobic physical training on CNP expression in HF patients.
- To assess the relationship between CNP levels and clinical/functional parameters after training.
Main Methods:
- 90 HF patients were randomized into a control group (19) or an aerobic exercise-training group (71).
- Intervention involved a 9-month home-based aerobic exercise program.
- Measurements included plasma CNP, B-type natriuretic peptide (BNP), norepinephrine, echocardiogram, and cardiopulmonary-stress test.
Main Results:
- Trained patients showed improved peak oxygen uptake (VO2) and ejection fraction.
- Aerobic training led to decreased plasma levels of norepinephrine, BNP, and CNP.
- The reduction in CNP correlated with increased peak VO2, and the CNP-BNP relationship was maintained.
Conclusions:
- Physical training in HF patients improves clinical and functional status.
- This improvement is linked to reduced adrenergic activation and lower CNP and BNP concentrations.
- Decreased CNP plasma levels post-training may indicate improved endothelial function.
Background:
C-type natriuretic peptide (CNP) is structurally related to cardiac natriuretic peptides and is currently considered as an endothelium-derived hyperpolarizing factor. Endothelial dysfunction, commonly observed in chronic heart failure (HF) patients is positively affected by physical training.
Methods:
To evaluate the effect of aerobic physical training on the expression of CNP, 90 HF patients on optimal pharmacological treatment (age 62+/-2 years, mean+/-SEM), randomly assigned in a 3 : 1 ratio to either control group (C, 19 patients) or home-based aerobic exercise-training program group (T, 71 patients), completed the protocol. Plasma assay of CNP, brain natriuretic peptide or B-type natriuretic peptide (BNP), and norepinephrine; echocardiogram; and cardiopulmonary-stress test were performed in all patients at enrollment and after 9 months.
Results:
At baseline, in both groups, CNP plasma level was significantly related to BNP (R=0.50), ejection fraction (R=0.43), and peak oxygen uptake (VO2, R=0.43, all P<0.001). After 9 months, trained patients showed an improvement in peak VO2 (P<0.001) and ejection fraction (P<0.05), whereas norepinephrine (P<0.05), BNP (P<0.001), and CNP (P<0.001) decreased. No changes occurred in group C. In group T, the decrease in CNP was significantly related to the increase in peak VO2 (R=0.31, P<0.01), and the relation between CNP and BNP was preserved at the end of the program (R=0.41, P<0.001).
Conclusion:
Clinical and functional improvement after physical training in HF patients is associated with a decrease in adrenergic activation and in both CNP and BNP concentration. Changes in CNP plasma concentration after physical training might reflect an improvement in endothelial function.
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