Abstract 13829: The Effects of Exercise Training on Systemic Brain Natriuretic Peptide (BNP) and N-terminal BNP Expression in Heart Failure Patients: An Individual Patient Meta-analysis
Background: BNP and the N-terminal portion (NT-pro-BNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure. Exercise training has been shown to reduce BNP/NT-pro-BNP levels - in either non-randomized and/or small randomized studies, which limit the generalizability of the results. We therefore obtained individual patient data from several studies and examined the hypothesis that changes in BNP, NT-pro-BNP, peak VO2 were related to the different training regimen applied. Additionally we aimed to identify patient characteristics that increase the likelihood of exercise-induced reduction in BNP, NT-pro-BNP and peak VO2.
Methods: A systematic search of Medline (Ovid), Embase.com, Cochrane Central Register of Controlled Trials and CINAHL (up until July 2008) identified randomized controlled trials of aerobic and/or resistance exercise training in systolic heart failure patients measuring BNP and/or Pro-BNP. Primary outcome measures were change in BNP, NT-pro-BNP and peak VO2. Other independent variables were exercise energy expenditure, exercise program intensity, duration and number of sessions. Sub-analyses were conducted to identify (1) patient groups that may benefit the most, (2) exercise program parameters that may enhance favourable changes in primary outcome measures.
Results: Ten randomized controlled studies met our eligibility criteria, authors providing individual patient data for a total of 565 patients (313 exercise and 252 controls). Exercise training had a favorable effect on BNP (–28.3%, p<.0001), NT-pro-BNP (–37.4%, p=<.0001) and peak VO2 (17.8%, p<.0001). We observed a low but significant correlation between change in peak VO2 and change in BNP (r=–.31, p<.0001) and change in NT-pro-BNP (r=–.22, p<.0001). Patients with LVEF<34% and peak VO2<14ml· kg–1· min–1 showed largest reductions in BNP and NT-pro-BNP. Mena weekly exercise energy expenditure >457 Kcal·week–1 was correlated with improved BNP (r=.19, p=.04), and peak VO2 (r=.45, p<.0001).
Conclusion: Individual patient meta-analysis suggests exercise training has a favorable effect on BNP, NT-pro-BNP and peak VO2 in heart failure patients. Patients with lower LVEF and peak VO2 appear to benefit the most.
- © 2010 by American Heart Association, Inc.