CLINICAL RESEARCH: HEART FAILURE
Aerobic Training Decreases B-Type Natriuretic Peptide Expression and Adrenergic Activation in Patients With Heart Failure
Claudio Passino, MD*, ,*,
Silvia Severino, MS*,
Roberta Poletti, MD*,
Massimo F. Piepoli, MD ,
Chiara Mammini, MD*,
Aldo Clerico, MD*, ,
Alessandra Gabutti, MD*,
Guido Nassi, MS* and
Michele Emdin, MD, PhD*
* Cardiovascular Medicine Department, CNR Institute of Clinical Physiology, Pisa, Italy
Scuba Superiore S. Anna, Pisa, Italy
G. da Saliceto Hospital, Piacenza, Italy
Manuscript received September 21, 2005;
revised manuscript received December 5, 2005,
accepted December 13, 2005.
* Reprint requests and correspondence: Dr. Claudio Passino, CNR Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy (Email: passino{at}ifc.cnr.it).
OBJECTIVES: We sought to evaluate the effect of physical training on neurohormonal activation in patients with heart failure (HF).
BACKGROUND: Patients with HF benefit from physical training. Chronic neurohormonal activation has detrimental effects on ventricular remodeling and prognosis of patients with HF.
METHODS: A total of 95 patients with HF were assigned randomly into two groups: 47 patients (group T) underwent a nine-month training program at 60% of the maximal oxygen uptake (VO2), whereas 48 patients did not (group C). The exercise load was adjusted during follow-up to achieve a progressive training effect. Plasma assay of B-type natriuretic peptide (BNP), amino-terminal pro-brain natriuretic peptide (NT-proBNP), norepinephrine, plasma renin activity, and aldosterone; quality-of-life questionnaire; echocardiogram; and cardiopulmonary stress test were performed upon enrollment and at the third and ninth month.
RESULTS: A total of 85 patients completed the protocol (44 in group T, left ventricular ejection fraction [EF] 35 ± 2%, mean ± SEM; and 41 in group C, EF 32 ± 2%, p = NS). At the ninth month, patients who underwent training showed an improvement in workload (+14%, p < 0.001), peak VO2 (+13%, p < 0.001), systolic function (EF +9%, p < 0.01), and quality of life. We noted that BNP, NT-proBNP, and norepinephrine values decreased after training (34%, p < 0.01; 32%, p < 0.05; 26%, p < 0.01, respectively). Increase in peak VO2 with training correlated significantly with the decrease in both BNP/NT-proBNP level (p < 0.001 and p < 0.01, respectively). Patients who did not undergo training showed no changes.
CONCLUSIONS: Clinical benefits after physical training in patients with HF are associated with blunting of adrenergic overactivity and of natriuretic peptide overexpression.
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Abbreviations and Acronyms
| | BNP = B-type natriuretic peptide | | CPT = cardiopulmonary stress test | | EF = ejection fraction | | HF = heart failure | | NT-proBNP = amino-terminal pro-brain natriuretic peptide | | NYHA = New York Heart Association | | QOL = quality of life | | VE/VCO2 = ventilation/carbon dioxide production ratio | | VO2 = oxygen uptake |
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