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Cardiac peptides during exercise test in ischemic and non-ischemic heart failure patients
Maria Ilea1, D Zdrenghea, G Bodisz
1Department of Cardiology, Rehabilitation Hospital, Cluj-Napoca, Romania. maria_ilea@yahoo.com
Insights
Cardiac peptides like NT-proBNP increase during exercise in heart failure patients. Nonischemic patients show a greater increase than ischemic patients, suggesting intracardiac pressure is key.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Cardiac peptides are elevated in heart failure and increase during myocardial ischemia.
- Exercise exacerbates cardiac peptide levels in heart failure patients.
- The differential response of cardiac peptides to exercise in ischemic versus nonischemic heart failure is not well-established.
Purpose of the Study:
- To investigate the differences in cardiac peptide levels (NT-proBNP and NT-proANP) at rest and during exercise between ischemic and nonischemic heart failure patients.
- To explore the relationship between cardiac peptide response, left ventricular function, and intracardiac pressure during exercise.
Main Methods:
- Studied 50 heart failure patients (32 ischemic, 18 nonischemic) undergoing symptom-limited exercise stress tests.
- Measured plasma levels of NT-proBNP and NT-proANP at rest and peak exercise using ELISA.
- Analyzed differences in peptide levels and their correlation with left ventricular ejection fraction.
Main Results:
- At rest, NT-proBNP and NT-proANP were higher in nonischemic patients (p=0.016 for NT-proBNP).
- During exercise, both peptides increased, with significantly higher levels in nonischemic patients (p<0.05 for NT-proBNP).
- Myocardial ischemia did not further elevate cardiac peptides; intracardiac pressure, indicated by lower LVEF in nonischemic patients, appeared more influential.
Conclusions:
- Nonischemic heart failure patients exhibit higher resting and exercise-induced levels of cardiac peptides compared to ischemic patients.
- The increased ventricular stretching, rather than ischemia itself, drives cardiac peptide elevation during exercise.
- Lower left ventricular systolic function in nonischemic patients correlates with elevated cardiac peptides, highlighting intracardiac pressure as a critical factor.
Background:
Cardiac peptides are increased at rest in heart failure patients representing a useful diagnostic tool for this condition. Recently it has been demonstrated that cardiac peptides increase also during myocardial ischemia. Cardiac peptides increase during exercise in heart failure patients, but it has not been established yet if the increase is the same in ischemic and nonischemic patients.
Methods:
There were studied 50 heart failure patients, 32 ischemic and 18 nonischemic, 35 males and 15 females aged 61.8 +/- 11.61 after the relief of congestive syndrome, which was submitted to a symptom-limited exercise stress test on a cycloergometer. Blood samples were obtained at rest and at a peak effort and the plasmatic values of NT-proBNP (NV<250 fmoles/mL) and of NT-proANP (NV<1950 fmoles/mL) were determined using the ELISA method.
Results:
At rest, both NT-proBNP and NT-proANP were more increased in nonischemic (1104.33 +/- 730; 3275.55 +/- 3424) than in ischemic patients (685.68 +/- 452.01, 2265.0 +/- 2552.32) with significant differences only for NT-proBNP (p=0.016). During exercise NT-proBNP increase from 836.40 +/- 596.34 to 1403.92 +/- 2126.21 and NT-proANP from 2628.80 +/- 2903.41 to 3701.30 +/- 3237.76, the final values being again more increased in nonischemic patients (NT-proBNP-2945.44 +/- 3257.89; NT-proANP-3174 +/- 2905); for NT-proBNP p<0.05. The results suggest that the stretching effect during exercise is more increased at the ventricular level in comparison with the atrial level (67% increase for NT-proBNP and only 40% for NT-proANP). Surprisingly, myocardial ischemia does not increase additionally cardiac peptides either at rest or during exercise. Our data suggest that the intracardiac pressure is more important than ischemia in determining the increase of cardiac peptides in heart failure patients because the left ventricular ejection fraction was lower in nonischemic patients (40.03 +/- 5.5 vs 38.11 +/- 4.07).
Conclusion:
Cardiac peptides are increased, both at rest and during exercise, in nonischemic heart failure patients in comparison with ischemic ones, probably in relationship with the lower left ventricular systolic function.
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