Abstract 11902: Exercise in Heart Failure and Patterns of Inflammation and Myocardial Stress Over Time
Background: Regular exercise is recommended to improve physical function in patients with heart failure (HF). Exercise is known to decrease inflammation and thought to decrease myocardial stress. Studies of N-terminal pro b-type natriuretic (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) have been mixed in patients with HF and physiologic heterogeneity in response to exercise training is common. A multi-marker analysis may help identify distinct subgroups of HF patients who respond to exercise.
Objectives: Identify common and distinct patterns of change in serum biomarkers of hsCRP and NT-proBNP and quantify the influence of exercise therapy on the patterns of change.
Methods: NT-proBNP and hsCRP were assessed in a random sample of 320 participants from the biomarker sub-study of the HF-ACTION study, a randomized clinical trial of exercise training versus usual care in patients with stable and chronic HF. Growth mixture modeling was used to identify unique biomarker patterns measured over 12-months.
Results: Three statistically independent and clinically meaningful biomarker patterns of NTproBNP and hsCRP were identified (Figure 1). The largest “lowest and improving,” pattern (61%) had the lowest levels of NT-proBNP and hsCRP at baseline, with declines over time. The second “elevated and stable” pattern (34%) had higher hs-CRP and consistent NT-proBNP over time. The smallest and most deleterious “elevated and worsening” pattern (5%) had the highest levels of NT-proBNP and increasing hsCRP (p<0.001) over time. Participants randomized to the exercise intervention were much less likely to have the elevated/worsening pattern of NT-proBNP and hsCRP (relative risk ratio: 0.23, CI: 0.06-0.92, p=0.037).
Conclusions: Exercise therapy was protective for reducing the frequency of membership in the worst pattern, indicating that exercise may help slow the progression of HF.
Author Disclosures: R.M. Masterson Creber: Research Grant; Significant; NIH/NINR F31NR014086-01, Patricia G. Archbold pre-doctoral Scholarship, National Hartford Centers of Geriatric Nursing Excellence. C.S. Lee: Research Grant; Significant; NIH/NINR, American Heart Association, Office of Research on Women’s Health. K. Margulies: None. S. Ellis: None. B. Riegel: None.
- © 2014 by American Heart Association, Inc.