Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure

Giuseppe Rengo, Gennaro Pagano, Valentina Parisi, Grazia Daniela Femminella, Claudio De Lucia, Daniela Liccardo, Alessandro Cannavo, Carmela Zincarelli, Klara Komici, Stefania Paolillo, Flavia Fusco, Walter J. Koch, Pasquale Perrone Filardi, Nicola Ferrara, Dario Leosco

Research output: Contribution to journalArticle

Abstract

Background Short-term changes of neurohormones can give important prognostic information in heart failure (HF) patients. In this study, we evaluate whether changes in plasma Norepinephrine (NE) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) after exercise training predict cardiac mortality in HF patients. Methods and results We enrolled 221 HF patients (mean age 72.5 ± 10.2 year) followed-up for a mean period of 27.64 ± 10.7 months. All pts underwent a 3-month exercise training. Before training, clinical examination, echocardiography, peak VO2 determination, and blood draw for NT-proBNP and NE measurements were performed. Primary end-point was cardiac related mortality. Eighty-six-nine percent of patients were in NYHA class III, mean left ventricular ejection fraction (LVEF) was 32.5 ± 10.4%, and mean peak VO2 was 12.36 ± 1.45 ml/kg/min. At baseline, mean NT-proBNP was 2111.4 ± 1145.6 pg/ml and mean NE was 641.8 ± 215.3 pg/ml. One hundred-one subjects died for cardiac causes. Training was associated with a significant increase of peak VO2 and LVEF, whereas NE, NT-proBNP, and heart rate decreased. Multiple Cox proportional hazards regression analysis was performed using delta% values (post vs pre-training) of LVEF, heart rate, NE, and NT-proBNP along with baseline covariates, revealing delta value of NE as the strongest predictor of cardiac mortality. Noteworthy, training reduced NT-proBNP in both survivor and non-survivor patients, while a lack of reduction of NE was observed in non survivors. Conclusions In our HF population, short-term changes of NE after exercise training independently predicted long-term cardiac mortality.

Original languageEnglish
Pages (from-to)384-389
Number of pages6
JournalInternational Journal of Cardiology
Volume171
Issue number3
DOIs
Publication statusPublished - Feb 15 2014

Keywords

  • Exercise training
  • Heart failure
  • N-terminal pro-brain natriuretic peptide
  • Norepinephrine
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Rengo, G., Pagano, G., Parisi, V., Femminella, G. D., De Lucia, C., Liccardo, D., Cannavo, A., Zincarelli, C., Komici, K., Paolillo, S., Fusco, F., Koch, W. J., Perrone Filardi, P., Ferrara, N., & Leosco, D. (2014). Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure. International Journal of Cardiology, 171(3), 384-389. https://doi.org/10.1016/j.ijcard.2013.12.024