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Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure
Author(s) -
Kato M.,
Kinugawa T.,
Ogino K.,
Endo A.,
Osaki S.,
Igawa O.,
Hisatome I.,
Shigemasa C.
Publication year - 2000
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.2000.00736.x
Subject(s) - medicine , heart failure , cardiology , brain natriuretic peptide , natriuretic peptide
. Kato M, Kinugawa T, Ogino K, Endo A, Osaki S, Igawa O, Hisatome I, Shigemasa C (Tottori University Faculty of Medicine, Yonago, Japan). Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure. J Intern Med 2000; 248: 309–315. Objectives. We have previously demonstrated that patients with symptomatic congestive heart failure (CHF), but not with asymptomatic left ventricular dysfunction (LVD), have augmented plasma atrial natriuretic peptide (ANP) response to exercise. Plasma brain natriuretic peptide (BNP) response to exercise is less extensively studied. The aim of this study was to determine whether responses of plasma BNP during exercise normalized for exercise workload are altered in patients with LVD and CHF. Subjects and methods. Twenty‐nine patients with LVD, 32 patients with CHF (NYHA classes II–III) and 27 age‐matched control subjects were studied. Ventilatory, plasma ANP and BNP responses were assessed during symptom‐limited cardiopulmonary exercise testing. Plasma natriuretic peptide levels were measured at rest and immediately after peak exercise. The increment in plasma BNP was divided by the increment in oxygen uptake ( V o 2 ) from rest to peak exercise, and this ratio [BNP exercise ratio: (peak BNP – rest BNP)/(peak V o 2 – rest V o 2 )] was compared amongst the three groups. Results. Peak V o 2 (Control, LVD and CHF: 28.2 ± 1.7, 21.1 ± 1.8, 16.2 ± 0.6 mL min −1 kg −1 , respectively), anaerobic threshold and peak workload became smaller as heart failure worsened. Resting and peak plasma ANP levels were significantly higher only in CHF, whilst resting and peak plasma BNP levels displayed a significant and continuous increase from normal subjects to LVD and CHF. The ANP exercise ratio (1.25 ± 0.36, 2.61 ± 0.57, 7.72 ± 1.65, anova P = 0.0002) was significantly higher only in patients with CHF, whilst the BNP exercise ratio (0.35 ± 0.10, 2.60 ± 0.69, 4.98 ± 0.97, anova P = 0.0001) was significantly higher in patients with LVD and became progressively higher in patients with CHF. Conclusions. These data showed that the BNP exercise ratio, an exercise plasma BNP response normalized with exercise workload, was augmented in patients with LVD, and became progressively higher in CHF, suggesting that an augmented exercise BNP ratio exists early in the course of developing CHF.