Is hormonal activation during exercise useful for risk stratification in patients with moderate congestive heart failure?

• Published in: The American heart journal 2004-08, Vol.148 (2), p.349-355
• Main Authors: de Groote, Pascal, Soudan, Benoît, Lamblin, Nicolas, Rouaix-Emery, Nathalie, Mc Fadden, Eugène, Meurice, Thibaut, Mouquet, Frédéric, Bauters, Christophe
• Format: Article
• Language: English
• Subjects: Atrial Natriuretic Factor - blood; Biological and medical sciences; Carbon dioxide; Cardiology. Vascular system; Catheters; Drug therapy; Exercise - physiology; Exercise Test; Follow-Up Studies; Heart; Heart Atria - pathology; Heart failure; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart rate; Humans; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Nordefrin - blood; Oxygen - metabolism; Peptides; Plasma; Population; Prognosis; Risk Assessment - methods; Stroke Volume; Studies; Survival Analysis; Ventilation
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2004.03.044

We previously demonstrated that A-type natriuretic peptide (ANP) at peak exercise was an independent predictor of cardiac survival. No data are available concerning the predictive value of B-type natriuretic peptide (BNP) at peak exercise. One hundred and fifty consecutive stable patients with moderate congestive heart failure (CHF) underwent echocardiography and a cardiopulmonary exercise test. Blood samples were drawn at rest and at peak exercise for the determination of plasma levels of ANP, BNP, and norepinephrine. Exercise significantly increased plasma values of ANP, BNP, and norepinephrine. After a median follow-up period of 1171 days, there were 35 cardiac related deaths. Mortality rates at 1 and 2 years were 4% and 8%, respectively. Independent predictors of cardiac survival were percent of maximal predicted oxygen consumption (RR = 4.8 [2.1–11], P = .002), BNP at rest (RR = 2.5 [1.2–5.6], P = .01), and left atrial diameter (RR = 2.8 [1.2–6.5], P = .02). In patients with stable, moderate CHF, plasma levels of ANP, BNP, and norepinephrine measured at peak exercise did not improve risk stratification. However, in addition to percent of maximal predicted oxygen consumption and left atrial diameter, plasma level of BNP at rest was an independent predictor of survival in CHF patients with low risk of cardiac events.