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CLINICAL STUDY: DIAGNOSTICS AND HEART FAILURE

brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure

Stefan Krüger, MD^*,*, J.ürgen Graf, MD^*, Dagmar Kunz, MD, Tina Stickel, Cand Med^*, Peter Hanrath, MD, FESC, FACC^* and Uwe Janssens, MD, FESC^*

^* Medical Clinic I, University Hospital, University of Technology, Aachen, Germany
Institute of Clinical Chemistry and Pathobiochemistry, University Hospital, University of Technology, Aachen, Germany

Manuscript received March 21, 2002; revised manuscript received April 29, 2002, accepted May 23, 2002.

^* Reprint requests and correspondence: Dr. Stefan Krüger, Medizinische Klinik I, Universitätsklinikum, Rheinisch Westfälische Technische Hochschule, Pauwelsstraße 30, 52057 Aachen, Germany.
SKrueger{at}ukaachen.de

OBJECTIVES: The goal of this study was to determine if brain natriuretic peptide (BNP) levels are associated with exercise capacity in patients with chronic heart failure (HF).

BACKGROUND: Plasma levels of BNP are increased subject to the degree of systolic and diastolic left ventricular dysfunction in patients with chronic HF. Exercise testing is useful to assess functional capacity and prognosis in chronic HF.

METHODS: We prospectively studied 70 consecutive patients with chronic HF (60.3 ± 10.4 years, 51 men) referred for cardiopulmonary exercise testing. Resting BNP was obtained after 10 min of supine rest before symptom-limited bicycle exercise testing.

RESULTS: In patients with chronic HF, BNP levels correlated with oxygen uptake (VO₂), both at anaerobic threshold (VO₂AT: r = –0.54, p < 0.001) and peak exercise (peak VO₂: r = –0.56, p < 0.001). Impairment of ventilatory efficiency (EqCO₂: r = 0.43, p < 0.001) and maximum exercise level (W % predicted: r = –0.44, p < 0.05) correlated less well with BNP. There was a significant inverse correlation between left ventricular ejection fraction and BNP (r = –0.50, p < 0.05). Brain natriuretic peptide discriminated well chronic HF patients with a peak VO₂ <10 ml/min/kg (area under the receiver operating characteristic [ROC] 0.93) or <14 ml/min/kg (area under the ROC 0.72). A BNP >316 pg/ml was associated with a risk ratio of 6.8 (95% confidence interval, 2.3 to 19.8) for a reduced exercise capacity with a peak VO₂ <14 ml/min/kg.

CONCLUSIONS: Brain natriuretic peptide is clearly associated with exercise capacity in chronic HF. Brain natriuretic peptide levels show a significant correlation with the impairment of VO₂ at peak exercise and anaerobic threshold. Brain natriuretic peptide is able to differentiate between chronic HF patients with moderately and severely impaired exercise capacity.

Abbreviations and Acronyms   AT   anaerobic threshold   AUROC   area under the receiver operating characteristic curve   BNP   brain natriuretic peptide   CI   confidence interval   EqCO2   ventilatory efficiency   HF   heart failure   LVEF   left ventricular ejection fraction   VO2   oxygen uptake

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