TY - JOUR
T1 - The effects of exercise on cardiovascular biomarkers in patients with chronic heart failure
AU - Ahmad, Tariq
AU - Fiuzat, Mona
AU - Mark, Daniel B.
AU - Neely, Ben
AU - Neely, Megan
AU - Kraus, William E.
AU - Kitzman, Dalane W.
AU - Whellan, David J.
AU - Donahue, Mark
AU - Zannad, Faiez
AU - Piña, Ileana L.
AU - Adams, Kirkwood
AU - O'Connor, Christopher M.
AU - Felker, G. Michael
N1 - Funding Information:
Drs Felker, Fiuzat, and O'Connor have received research funding from BG Medicine, Critical Diagnostics, and Roche Diagnostics. Drs Felker and O'Connor have served as consultants for Roche Diagnostics. Dr Zannad has received research funding from BG Medicine and Roche Diagnostics and served as a consultant for BG Medicine. Dr Kitzman serves as a consultant for Relypsa, Inc. None of the other authors report any conflicts.
Funding Information:
Dr Ahmad received support from the Daland Fellowship in Clinical Investigation. The HF-ACTION study was funded by grants from the National Heart, Lung, and Blood Institute. The biomarkers assays were funded by a grant from Roche Diagnostics. No other extramural funding was used to support this work. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.
PY - 2014/2
Y1 - 2014/2
N2 - Background Exercise training is recommended for chronic heart failure (HF) patients to improve functional status and reduce risk of adverse outcomes. Elevated plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cardiac troponin T (cTnT) are associated with increased risk of adverse outcomes in this patient population. Whether exercise training leads to improvements in biomarkers and how such improvements relate to clinical outcomes are unclear. Methods and Results Amino-terminal pro-brain natriuretic peptide, hs-CRP, and cTnT levels were assessed at baseline and 3 months in a cohort of 928 subjects from the HF-ACTION study, a randomized clinical trial of exercise training versus usual care in chronic HF patients with reduced left ventricular ejection fraction (<35%). Linear and logistic regressions were used to assess 3-month biomarker levels as a function of baseline value, treatment assignment (exercise training vs usual care), and volume of exercise. Linear regression and Cox proportional hazard modeling were used to evaluate the relations between changes in biomarker levels and clinical outcomes of interest that included change in peak oxygen consumption (peak VO2), hospitalizations, and mortality. Exercise training was not associated with significant changes in levels of NT-proBNP (P =.10), hs-CRP (P =.80), or detectable cTnT levels (P =.83) at 3 months. Controlling for baseline biomarker levels or volume of exercise did not alter these findings. Decreases in plasma concentrations of NT-proBNP, but not hs-CRP or cTnT, were associated with increases in peak VO2 (P <.001) at 3 months and decreased risk of hospitalizations or mortality (P ≤.04), even after adjustment for a comprehensive set of known predictors. Conclusions Exercise training did not lead to meaningful changes in biomarkers of myocardial stress, inflammation, or necrosis in patients with chronic HF. Only improvements in NT-proBNP translated to reductions in peak VO2 and reduced risk of clinical events.
AB - Background Exercise training is recommended for chronic heart failure (HF) patients to improve functional status and reduce risk of adverse outcomes. Elevated plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cardiac troponin T (cTnT) are associated with increased risk of adverse outcomes in this patient population. Whether exercise training leads to improvements in biomarkers and how such improvements relate to clinical outcomes are unclear. Methods and Results Amino-terminal pro-brain natriuretic peptide, hs-CRP, and cTnT levels were assessed at baseline and 3 months in a cohort of 928 subjects from the HF-ACTION study, a randomized clinical trial of exercise training versus usual care in chronic HF patients with reduced left ventricular ejection fraction (<35%). Linear and logistic regressions were used to assess 3-month biomarker levels as a function of baseline value, treatment assignment (exercise training vs usual care), and volume of exercise. Linear regression and Cox proportional hazard modeling were used to evaluate the relations between changes in biomarker levels and clinical outcomes of interest that included change in peak oxygen consumption (peak VO2), hospitalizations, and mortality. Exercise training was not associated with significant changes in levels of NT-proBNP (P =.10), hs-CRP (P =.80), or detectable cTnT levels (P =.83) at 3 months. Controlling for baseline biomarker levels or volume of exercise did not alter these findings. Decreases in plasma concentrations of NT-proBNP, but not hs-CRP or cTnT, were associated with increases in peak VO2 (P <.001) at 3 months and decreased risk of hospitalizations or mortality (P ≤.04), even after adjustment for a comprehensive set of known predictors. Conclusions Exercise training did not lead to meaningful changes in biomarkers of myocardial stress, inflammation, or necrosis in patients with chronic HF. Only improvements in NT-proBNP translated to reductions in peak VO2 and reduced risk of clinical events.
UR - http://www.scopus.com/inward/record.url?scp=84892829614&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892829614&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2013.10.018
DO - 10.1016/j.ahj.2013.10.018
M3 - Article
C2 - 24439980
AN - SCOPUS:84892829614
SN - 0002-8703
VL - 167
SP - 193-202.e1
JO - American heart journal
JF - American heart journal
IS - 2
ER -