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Response of B-type natriuretic peptide to exercise in hypertensive patients with suspected diastolic heart failure: correlation with cardiac function, hemodynamics, and workload.
Am Heart J. 2004 Aug; 148(2):365-70.AH

Abstract

BACKGROUND

Diastolic heart failure (DHF) is characterized by dyspnea due to increased left ventricular (LV) filling pressures during stress. We sought the relationship of exercise-induced increases in B-type natriuretic peptide (BNP) to LV filling pressures and parameters of cardiovascular performance in suspected DHF.

METHODS

Twenty-six treated hypertensive patients with suspected DHF (exertional dyspnea, LV ejection fraction >50%, and diastolic dysfunction) underwent maximal exercise echocardiography using the Bruce protocol. BNP, transmitral Doppler, and tissue Doppler for systolic (Sa) and early (Ea) and late (Aa) diastolic mitral annular velocities were obtained at rest and peak stress. LV filling pressures were estimated with E/Ea ratios.

RESULTS

Resting BNP correlated with resting pulse pressure (r=0.45, P=0.02). Maximal exercise performance (4.6 +/- 2.5min) was limited by dyspnea. Blood pressure increased with exercise (from 143 +/- 19/88 +/- 8 to 191 +/- 22/ 90 +/- 10 mm Hg); 13 patients (50%) had a hypertensive response. Peak exercise BNP correlated with peak transmitral E velocity (r = 0.41, P <.05) and peak heart rate (r = -0.40, P <.05). BNP increased with exercise (from 48 +/- 57 to 74 +/- 97 pg/mL, P =.007), and the increment of BNP with exercise was associated with maximal workload and peak exercise Sa, Ea, and Aa (P <.01 for all). Filling pressures, approximated by lateral E/Ea ratio, increased with exercise (7.7 +/- 2.0 to 10.0 +/- 4.8, P <.01). BNP was higher in patients with possibly elevated filling pressures at peak exercise (E/Ea >10) compared to those with normal pressures (123 +/- 124 vs 45 +/- 71 pg/mL, P =.027).

CONCLUSIONS

Augmentation of BNP with exercise in hypertensive patients with suspected DHF is associated with better exercise capacity, LV systolic and diastolic function, and left atrial function. Peak exercise BNP levels may identify exercise-induced elevation of filling pressures in DHF.

Authors+Show Affiliations

University of Queensland, Brisbane, Australia.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15309010

Citation

Mottram, Philip M., et al. "Response of B-type Natriuretic Peptide to Exercise in Hypertensive Patients With Suspected Diastolic Heart Failure: Correlation With Cardiac Function, Hemodynamics, and Workload." American Heart Journal, vol. 148, no. 2, 2004, pp. 365-70.
Mottram PM, Haluska BA, Marwick TH. Response of B-type natriuretic peptide to exercise in hypertensive patients with suspected diastolic heart failure: correlation with cardiac function, hemodynamics, and workload. Am Heart J. 2004;148(2):365-70.
Mottram, P. M., Haluska, B. A., & Marwick, T. H. (2004). Response of B-type natriuretic peptide to exercise in hypertensive patients with suspected diastolic heart failure: correlation with cardiac function, hemodynamics, and workload. American Heart Journal, 148(2), 365-70.
Mottram PM, Haluska BA, Marwick TH. Response of B-type Natriuretic Peptide to Exercise in Hypertensive Patients With Suspected Diastolic Heart Failure: Correlation With Cardiac Function, Hemodynamics, and Workload. Am Heart J. 2004;148(2):365-70. PubMed PMID: 15309010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Response of B-type natriuretic peptide to exercise in hypertensive patients with suspected diastolic heart failure: correlation with cardiac function, hemodynamics, and workload. AU - Mottram,Philip M, AU - Haluska,Brian A, AU - Marwick,Thomas H, PY - 2004/8/17/pubmed PY - 2005/1/14/medline PY - 2004/8/17/entrez SP - 365 EP - 70 JF - American heart journal JO - Am. Heart J. VL - 148 IS - 2 N2 - BACKGROUND: Diastolic heart failure (DHF) is characterized by dyspnea due to increased left ventricular (LV) filling pressures during stress. We sought the relationship of exercise-induced increases in B-type natriuretic peptide (BNP) to LV filling pressures and parameters of cardiovascular performance in suspected DHF. METHODS: Twenty-six treated hypertensive patients with suspected DHF (exertional dyspnea, LV ejection fraction >50%, and diastolic dysfunction) underwent maximal exercise echocardiography using the Bruce protocol. BNP, transmitral Doppler, and tissue Doppler for systolic (Sa) and early (Ea) and late (Aa) diastolic mitral annular velocities were obtained at rest and peak stress. LV filling pressures were estimated with E/Ea ratios. RESULTS: Resting BNP correlated with resting pulse pressure (r=0.45, P=0.02). Maximal exercise performance (4.6 +/- 2.5min) was limited by dyspnea. Blood pressure increased with exercise (from 143 +/- 19/88 +/- 8 to 191 +/- 22/ 90 +/- 10 mm Hg); 13 patients (50%) had a hypertensive response. Peak exercise BNP correlated with peak transmitral E velocity (r = 0.41, P <.05) and peak heart rate (r = -0.40, P <.05). BNP increased with exercise (from 48 +/- 57 to 74 +/- 97 pg/mL, P =.007), and the increment of BNP with exercise was associated with maximal workload and peak exercise Sa, Ea, and Aa (P <.01 for all). Filling pressures, approximated by lateral E/Ea ratio, increased with exercise (7.7 +/- 2.0 to 10.0 +/- 4.8, P <.01). BNP was higher in patients with possibly elevated filling pressures at peak exercise (E/Ea >10) compared to those with normal pressures (123 +/- 124 vs 45 +/- 71 pg/mL, P =.027). CONCLUSIONS: Augmentation of BNP with exercise in hypertensive patients with suspected DHF is associated with better exercise capacity, LV systolic and diastolic function, and left atrial function. Peak exercise BNP levels may identify exercise-induced elevation of filling pressures in DHF. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15309010/Response_of_B_type_natriuretic_peptide_to_exercise_in_hypertensive_patients_with_suspected_diastolic_heart_failure:_correlation_with_cardiac_function_hemodynamics_and_workload_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304001681 DB - PRIME DP - Unbound Medicine ER -