Document Detail

Chronotropic and neurohumoral markers for the evaluation of functional capacity in patients with impaired left ventricular function.
MedLine Citation:
PMID:  18350779     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Brain natriuretic peptide (BNP) levels correlate with functional capacity in patients with heart failure. Autonomic dysfunction and baro-chemo reflex balance play a role in conditioning exercise tolerance and chronotropic competence in heart failure. In this study we examined the relationship between N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and heart rate (HR) response during cardiopulmonary exercise testing and the ability of those two markers to detect low functional class patients. METHODS: We studied 100 patients (age 59 +/- 13 yrs) with heart failure and left ventricular ejection fraction 35 +/- 9% who underwent treadmill cardiopulmonary exercise testing using the Dargie protocol. HR response was assessed by the chronotropic response index (CRI), which is calculated using the formula CRI = (peak HR - rest HR) /(220 - age - rest HR) x 100 (%). Blood samples for NT-pro-BNP assessment were taken before exercise. RESULTS: The overall peak VO2 achieved was 18 +/- 5 ml/kg/mm and CRI was 70 +/- 26% (normal value >80%). CRI correlated both with peak VO2 (r = 0.50, p < 0.001) and VE/VCO2 (r = -0.24, p < 0.05). Peak VO2 correlated strongly with NT-pro-BNP (r = -0.77, p < 0.001). NT-pro-BNP values >335 pg/ml showed 83% sensitivity and 76% specificity for detecting peak VO2 values <20 ml/kg/mm (AUC=86%, p < 0.001). CRI values >79% showed 70% sensitivity and 60% specificity for detecting peak VO2 values <20 ml/kg/mm (AUC=72%, p < 0.001). CRI correlated well with NT-pro-BNP at rest (r = -0.31, p < 0.001). CONCLUSIONS: In patients with heart failure, CR1 correlates significantly with both functional capacity derived from cardiopulmonary exercise testing and NT-pro-BNP levels. These findings may support the use of CR1 as a simple noninvasive marker of heart failure severity.
Manolis S Kallistratos; Athanlaslos Dritsas; Ioannis D Laoutaris; Dennis V Cokkinos
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē     Volume:  49     ISSN:  1109-9666     ISO Abbreviation:  -     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-03-20     Completed Date:  2008-04-10     Revised Date:  2009-02-12    
Medline Journal Info:
Nlm Unique ID:  101257381     Medline TA:  Hellenic J Cardiol     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  26-32     Citation Subset:  IM    
1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
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MeSH Terms
Exercise Test
Heart Rate / physiology*
Logistic Models
Middle Aged
Natriuretic Peptide, Brain / blood*
Oxygen Consumption
Peptide Fragments / blood*
Prospective Studies
ROC Curve
Stroke Volume
Ventricular Dysfunction, Left / blood,  physiopathology*
Reg. No./Substance:
0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain

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