| Title | N-terminal pro-brain natriuretic peptide and exercise capacity in chronic heart failure: data from the Heart Failure and a Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) study. | | Author(s) | Felker GM, Whellan D, Kraus WE, Clare R, Zannad F, Donahue M, Adams K, McKelvie R, Piña IL, O'Connor CM, HF-ACTION Investigators | | Institution | Duke Clinical Research Institute, Durham, NC 27705, USA. michael.felker@duke.edu | | Source | Am Heart J 2009 Oct; 158(4 Suppl):S37-44. | | MeSH | Aged
Biological Markers
Chronic Disease
Cohort Studies
Data Collection
Exercise Test
Exercise Tolerance
Female
Heart Failure
Humans
Male
Middle Aged
Natriuretic Peptide, Brain
Oxygen Consumption
Peptide Fragments
Prognosis
Protein Precursors
ROC Curve
Ventricular Dysfunction, Left
| | Abstract | OBJECTIVES: To examine the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and exercise capacity in a large contemporary cohort of patients with chronic heart failure.
BACKGROUND: Natriuretic peptides such as NT-proBNP are important biomarkers in heart failure. The relationship between NT-proBNP and exercise capacity has not been well studied.
METHODS: We analyzed the relationship between baseline NT-proBNP and peak oxygen uptake (peak VO(2)) or distance in the 6-minute walk test in 1383 subjects enrolled in the HF-ACTION study. Linear regression models were used to analyze the relationship between NT-proBNP and peak Vo(2) or distance in the 6-minute walk test in the context of other clinical variables. Receiver operator curve analysis was used to evaluate the ability of NT-proBNP to accurately predict a peak VO(2) <12 mL/kg per minute.
RESULTS: NT-proBNP was the most powerful predictor of peak VO(2) (partial R(2) = 0.13, P < .0001) of 35 candidate variables. Although NT-proBNP was also a predictor of distance in the 6-minute walk test, this relationship was weaker than that for peak VO(2) (partial R(2) = 0.02, P < .0001). For both peak VO(2) and distance in the 6-minute walk test, much of the variability in exercise capacity remained unexplained by the variables tested. Receiver operator curve analysis suggested NT-proBNP had moderate ability to identify patients with peak VO(2) <12 mL/kg per minute (c-index, 0.69).
CONCLUSIONS: In this analysis of baseline data from HF-ACTION, NT-proBNP was the strongest predictor of peak VO(2) and a significant predictor of distance in the 6-minute walk test. Despite these associations, NT-proBNP demonstrated only modest performance in identifying patients with a low peak VO(2) who might be considered for cardiac transplantation. These data suggest that, although hemodynamic factors are important determinants of exercise capacity, much of the variability in exercise performance in heart failure remains unexplained by traditional clinical and demographic variables. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
| | PubMed ID | 19782787 |
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