Abstract 16225: Short Term Changes in Neurohormones After Exercise Training Predict Prognosis in Patients With Heart Failure
Purpose: Short term changes of neurohormones can give important information on the effects of specific treatments on outcome of patients with heart failure (HF). In this study, we aimed to evaluate the degree to which the average exercise-induced changes in plasma Norepinephrine (NE) and serum N-Terminal pro-brain natriuretic peptide (NT-proBNP) are associated with corresponding intervention induced effects on cardiac mortality in HF.
Methods: We enrolled 221 pts (mean age was 72.5±10.2 yrs) with stable HF followed-up for a mean period of 27.64±10.7 months. All pts were referred to a 3-month exercise training program. Before training, a complete clinical examination, echocardiography, peak VO2 determination, and blood draw for serum N-NT-proBNP and plasma NE measurements were performed. Primary end-point was cardiac mortality.
Results: 86.9 % of patients were in NYHA class III, the mean LVEF was 32.5±10.4 % and the mean peak VO2 was 12.36±1.45 ml/kg/min. At baseline, mean serum NT-proBNP was 2111.4±1145 pg/mL and mean plasma NE was 641.8± pg/mL. N. 101 subjects died from cardiac causes at follow-up. Training significantly improved peak VO2 and LVEF, whereas NE, NT-proBNP, and heart rate decreased. Noteworthy, changes in NE and NT-proBNP were largely different when considered in pts stratified by survivors and non survivors. In fact, training reduced NT-proBNP in both groups, while a lack of reduction of NE was observed in almost the totality of non survivor patients. Multiple Cox proportional hazards regression analysis was performed using delta% values (post-training vs baseline values) of LVEF, heart rate, NE, and NT-proBNP along with baseline covariates (Table). Delta value of plasma NE resulted the strongest predictor of cardiac mortality.
Conclusions: Short-term changes of NE and NT-proBNP induced by exercise training are correlated with long-term cardiac mortality in HF patients.
- © 2013 by American Heart Association, Inc.