PMID- 11868044
OWN - NLM
STAT- MEDLINE
DCOM- 20020325
LR  - 20220409
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 143
IP  - 3
DP  - 2002 Mar
TI  - Stability of B-type natriuretic peptide levels during exercise in patients with 
      congestive heart failure: implications for outpatient monitoring with B-type 
      natriuretic peptide.
PG  - 406-11
AB  - BACKGROUND: B-natriuretic peptide (BNP), a neurohormone secreted from the cardiac 
      ventricles, reflects left ventricular pressure and correlates to disease severity 
      and prognosis. The fact that BNP levels can now be measured by a rapid assay 
      suggests its potential usefulness in the outpatient clinic. However, if patient 
      activity were to markedly alter BNP levels, its use would be less attractive for 
      monitoring patients in the outpatient clinical setting. METHODS: A total of 30 
      patients (10 normal, 10 New York Heart Association [NYHA] class I-II, 10 NYHA 
      class III-IV) exercised with an upright bicycle protocol. Exercise was carried 
      out to 75% of maximum heart rate, and venous blood was sampled before, 
      immediately after, and 1 hour after completion of exercise. Plasma levels of BNP, 
      epinephrine, and norepinephrine were measured. RESULTS: BNP levels at baseline 
      were 29 +/- 11 pg/mL for normal subjects, 126 +/- 26 pg/mL for NYHA I-II 
      subjects, and 1712 +/- 356 pg/mL for NYHA III-IV subjects. The change in BNP 
      levels with exercise was significantly lower than the change in epinephrine and 
      norepinephrine (P <.001). In normal subjects, BNP increased from 29 pg/mL to 44 
      pg/mL with peak exercise, still within the range of normal (<100 pg/mL). This is 
      compared with larger increases of norepinephrine (716 pg/mL to 1278 pg/mL) and 
      epinephrine (52 pg/mL to 86 pg/mL) with exercise in normal subjects. There were 
      also only small increases in BNP with exercise in patients with congestive heart 
      failure (NYHA I-II, 30%; NYHA III-IV, 18%). For the same groups, epinephrine 
      levels increased by 218% and 312%, respectively, and norepinephrine levels 
      increased by 232% and 163%, respectively. One hour after completion of exercise, 
      there were only minimal changes in BNP levels from baseline state in normal 
      subjects (+0.9%) and patients with NYHA I-II (3.8%). In patients with NYHA 
      III-IV, there was a 15% increase from baseline 1 hour after exercise. 
      CONCLUSIONS: BNP levels show only minor changes with vigorous exercise, making it 
      unlikely that a normal patient would be classified as having congestive heart 
      failure based on a BNP level obtained after activity. Prior activity should not 
      influence BNP levels in patients with congestive heart failure. Therefore, when a 
      patient presents to clinic with a marked change in their BNP level, it may 
      reflect a real change in their condition.
FAU - McNairy, Matthew
AU  - McNairy M
AD  - Division of Cardiology and the Department of Medicine, Veteran's Affairs Medical 
      Center and University of California, San Diego, Calif 92161, USA.
FAU - Gardetto, Nancy
AU  - Gardetto N
FAU - Clopton, Paul
AU  - Clopton P
FAU - Garcia, Alex
AU  - Garcia A
FAU - Krishnaswamy, Padma
AU  - Krishnaswamy P
FAU - Kazanegra, Radmila
AU  - Kazanegra R
FAU - Ziegler, Michael
AU  - Ziegler M
FAU - Maisel, Alan S
AU  - Maisel AS
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Biomarkers)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 85637-73-6 (Atrial Natriuretic Factor)
RN  - X4W3ENH1CV (Norepinephrine)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Atrial Natriuretic Factor/*blood
MH  - Biomarkers/blood
MH  - Epinephrine/blood
MH  - *Exercise Test
MH  - Female
MH  - Heart Failure/*blood
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain
MH  - Norepinephrine/blood
EDAT- 2002/02/28 10:00
MHDA- 2002/03/26 10:01
CRDT- 2002/02/28 10:00
PHST- 2002/02/28 10:00 [pubmed]
PHST- 2002/03/26 10:01 [medline]
PHST- 2002/02/28 10:00 [entrez]
AID - S000287030221892X [pii]
AID - 10.1067/mhj.2002.120148 [doi]
PST - ppublish
SO  - Am Heart J. 2002 Mar;143(3):406-11. doi: 10.1067/mhj.2002.120148.