Relation of B-Type Natriuretic Peptide Levels Before and After Exercise and Functional Capacity in Patients With Idiopathic Dilated Cardiomyopathy

      Although much is known about the value of B-type natriuretic peptide (BNP) at rest, the significance of the responsiveness of BNP during exercise in patients with chronic heart failure (HF) without coronary artery disease remains to be established. A role of BNP release during exercise in the functional disability of patients with chronic HF and idiopathic dilated cardiomyopathy (IDC) was hypothesized. One hundred five consecutive patients with an established diagnosis of HF and IDC who underwent symptom-limited cardiopulmonary exercise testing were studied. BNP was measured immediately before exercise and within 1 minute of the end of exercise. BNP at rest increased significantly at peak exercise (median from 66.5 (first, third quartiles 18, 168) to 72.0 pg/ml (26, 208), p <0.001), but BNP response was not uniform. BNP response increased in 63% of patients, did not change in 22%, and decreased in 15%. BNP at rest and BNP response showed an inverse correlation (p <0.001, r = −0.523). Aging and low left ventricular ejection fraction were independent predictors of higher BNP levels at rest, but lower BNP response. Beta-blocker therapy did not influence BNP response. BNP at rest correlated negatively with functional capacity (p <0.001, r = −0.516), whereas BNP response correlated positively (p = 0.002, r = 0.326). Patients with BNP release (vs patients without) had higher maximum oxygen consumption (19.2 ± 5.1 vs 15.9 ± 3.6, p <0.001), better functional capacity (59 ± 13% vs 50 ± 15%, p = 0.002), and lower minute ventilation/carbon dioxide production slope (33.6 ± 4.8 vs 36.5 ± 7.7, p = 0.026) independent of other clinical parameters. In conclusion, BNP release during exercise could be a determinant of functional capacity in patients with chronic HF and IDC.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Espiner E.A.
        Physiology of natriuretic peptides.
        J Intern Med. 1994; 235: 527-541
        • Levin E.R.
        • Gardner D.G.
        • Samson W.K.
        Natriuretic peptides.
        N Engl J Med. 1998; 339: 321-328
        • Koglin J.
        • Pehlivanli S.
        • Schwaiblmair M.
        • Vogeser M.
        • Cremer P.
        • vonScheidt W.
        Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure.
        J Am Coll Cardiol. 2001; 38: 1934-1941
        • Yasue H.
        • Yoshimura M.
        • Sumida H.
        • Kikuta K.
        • Kugiyama K.
        • Jougasaki M.
        • Ogawa H.
        • Okumura K.
        • Mukoyama M.
        • Nakao K.
        Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure.
        Circulation. 1994; 90: 195-203
        • Kruger S.
        • Graf J.
        • Kunz D.
        • Stickel T.
        • Hanrath P.
        • Janssens U.
        Brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure.
        J Am Coll Cardiol. 2002; 40: 718-722
        • de Groote P.
        • Dagorn J.
        • Soudan B.
        • Lamblin N.
        • McFadden E.
        • Bauters C.
        B-Type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure.
        J Am Coll Cardiol. 2004; 43: 1584-1589
        • Wasserman K.
        • Hansen J.E.
        • Sue D.Y.
        • Whipp B.J.
        Principles of exercise testing and interpretation. Lea and Febiger, Philadelphia, PA1986 (73)
        • Chua T.P.
        • Ponikowski P.
        • Harrington D.
        • Anker S.D.
        • Webb-Peploe K.
        • Clark A.L.
        • Poole-Wilson P.A.
        • Coats A.J.
        Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure.
        J Am Coll Cardiol. 1997; 29: 1585-1590
        • Kinugawa T.
        • Kato M.
        • Ogino K.
        • Osaki S.
        • Tomikura Y.
        • Igawa O.
        • Hisatome I.
        • Shigemasa C.
        Interleukin-6 and tumor necrosis factor-alpha levels increase in response to maximal exercise in patients with chronic heart failure.
        Int J Cardiol. 2003; 87: 83-90
        • Bentzen H.
        • Pedersen R.S.
        • Nyvad O.
        • Pedersen E.B.
        Effect of exercise on natriuretic peptides in plasma and urine in chronic heart failure.
        Int J Cardiol. 2004; 93: 121-130
        • Kato M.
        • Kinugawa T.
        • Ogino K.
        • Endo A.
        • Osaki S.
        • Igawa O.
        • Hisatome I.
        • Shigemasa C.
        Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure.
        J Intern Med. 2000; 248: 309-315
        • Kruger S.
        • Graf J.
        • Merx M.W.
        • Stickel T.
        • Kunz D.
        • Hanrath P.
        • Janssens U.
        Brain natriuretic peptide kinetics during dynamic exercise in patients with chronic heart failure.
        Int J Cardiol. 2004; 95: 49-54
        • Steele I.C.
        • McDowell G.
        • Moore A.
        • Campbell N.P.
        • Shaw C.
        • Buchanan K.D.
        • Nicholls D.P.
        Responses of atrial natriuretic peptide and brain natriuretic peptide to exercise in patients with chronic heart failure and normal control subjects.
        Eur J Clin Invest. 1997; 27: 270-276
        • Kjaer A.
        • Appel J.
        • Hildebrandt P.
        • Petersen C.L.
        Basal and exercise-induced neuroendocrine activation in patients with heart failure and in normal subjects.
        Eur J Heart Fail. 2004; 6: 29-39
        • Friedl W.
        • Mair J.
        • Thomas S.
        • Pichler M.
        • Puschendorf B.
        Relationship between natriuretic peptides and hemodynamics in patients with heart failure at rest and after ergometric exercise.
        Clin Chim Acta. 1999; 281: 121-126
        • McNairy M.
        • Gardetto N.
        • Clopton P.
        • Garcia A.
        • Krishnaswamy P.
        • Kazanegra R.
        • Ziegler M.
        • Maisel A.S.
        Stability of B-type natriuretic peptide levels during exercise in patients with congestive heart failure: implications for outpatient monitoring with B-type natriuretic peptide.
        Am Heart J. 2002; 143: 406-411
        • Bibbins-Domingo K.
        • Ansari M.
        • Schiller N.B.
        • Massie B.
        • Whooley M.A.
        B-Type natriuretic peptide and ischemia in patients with stable coronary disease: data from the Heart and Soul Study.
        Circulation. 2003; 108: 2987-2992
        • Sabatine M.S.
        • Morrow D.A.
        • de Lemos J.A.
        • Omland T.
        • Desai M.Y.
        • Tanasijevic M.
        • Hall C.
        • McCabe C.H.
        • Braunwald E.
        Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia.
        J Am Coll Cardiol. 2004; 44: 1988-1995
        • Marie P.Y.
        • Mertes P.M.
        • Hassan-Sebbag N.
        • de T.N.
        • Djaballah K.
        • Djaballah W.
        • Friberg J.
        • Olivier P.
        • Karcher G.
        • Zannad F.
        • Bertrand A.
        Exercise release of cardiac natriuretic peptides is markedly enhanced when patients with coronary artery disease are treated medically by beta-blockers.
        J Am Coll Cardiol. 2004; 43: 353-359
        • Passino C.
        • Poletti R.
        • Bramanti F.
        • Prontera C.
        • Clerico A.
        • Emdin M.
        Neuro-hormonal activation predicts ventilatory response to exercise and functional capacity in patients with heart failure.
        Eur J Heart Fail. 2006; 8: 46-53
        • Franciosa J.A.
        • Park M.
        • Levine T.B.
        Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure.
        Am J Cardiol. 1981; 47: 33-39
        • Coats A.J.
        Heart failure: what causes the symptoms of heart failure?.
        Heart. 2001; 86: 574-578
        • Florkowski C.M.
        • Richards A.M.
        • Espiner E.A.
        • Yandle T.G.
        • Frampton C.
        Renal, endocrine, and hemodynamic interactions of atrial and brain natriuretic peptides in normal men.
        Am J Physiol. 1994; 266: R1244-R1250
        • de Bold A.J.
        • Bruneau B.G.
        • Kuroski de Bold M.L.
        Mechanical and neuroendocrine regulation of the endocrine heart.
        Cardiovasc Res. 1996; 31: 7-18