Aerobic Training Decreases B-Type Natriuretic Peptide Expression and Adrenergic Activation in Patients With Heart Failure

• Published in: Journal of the American College of Cardiology 2006-05, Vol.47 (9), p.1835-1839
• Main Authors: Passino, Claudio, Severino, Silvia, Poletti, Roberta, Piepoli, Massimo F., Mammini, Chiara, Clerico, Aldo, Gabutti, Alessandra, Nassi, Guido, Emdin, Michele
• Format: Article
• Language: English
• Subjects: Aldosterone - blood; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Echocardiography; Efficiency; Exercise Test; Exercise Therapy; Exercise Tolerance; Female; Heart; Heart attacks; Heart failure; Heart Failure - blood; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart Failure - rehabilitation; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart rate; Hospitalization; Humans; Male; Medical sciences; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Neurotransmitter Agents - blood; Norepinephrine - blood; Peptide Fragments - blood; Peptides; Quality of Life; Renin - blood; Stroke Volume; Studies; Sympathetic Nervous System - physiopathology; Ventilation
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2005.12.050

Aerobic Training Decreases B-Type Natriuretic Peptide Expression and Adrenergic Activation in Patients With Heart Failure Claudio Passino, Silvia Severino, Roberta Poletti, Massimo F. Piepoli, Chiara Mammini, Aldo Clerico, Alessandra Gabutti, Guido Nassi, Michele Emdin To evaluate the effect of physical training on neurohormonal activation in subjects with chronic heart failure, 95 patients were randomized into group T (training) and group C (no training). Neurohormonal assays, quality-of-life (QOL) questionnaire, echocardiogram, and cardiopulmonary stress test were performed in all patients. At the ninth month, trained patients showed improvement of workload, peak oxygen uptake, systolic function, and QOL. B-type natriuretic peptide and norepinephrine plasma values decreased after training, with no changes in group C. Physical training benefit on functional capacity and QOL in patients with heart failure is associated with an improvement in neurohormonal imbalance. We sought to evaluate the effect of physical training on neurohormonal activation in patients with heart failure (HF). Patients with HF benefit from physical training. Chronic neurohormonal activation has detrimental effects on ventricular remodeling and prognosis of patients with HF. 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. 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 Vo2with training correlated significantly with the decrease in both BNP/NT-proBNP level (p < 0.001 and p