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

17 Citations (Scopus)

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

Fingerprint

Brain Natriuretic Peptide
Norepinephrine
Heart Failure
Exercise
Survival
Serum
Stroke Volume
Mortality
Survivors
Heart Rate
Neurotransmitter Agents
Echocardiography
Regression Analysis
Population

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure. / Rengo, Giuseppe; Pagano, Gennaro; Parisi, Valentina; Femminella, Grazia Daniela; De Lucia, Claudio; Liccardo, Daniela; Cannavo, Alessandro; Zincarelli, Carmela; Komici, Klara; Paolillo, Stefania; Fusco, Flavia; Koch, Walter J.; Perrone Filardi, Pasquale; Ferrara, Nicola; Leosco, Dario.

In: International Journal of Cardiology, Vol. 171, No. 3, 15.02.2014, p. 384-389.

Research output: Contribution to journalArticle

Rengo, G, Pagano, G, Parisi, V, Femminella, GD, De Lucia, C, Liccardo, D, Cannavo, A, Zincarelli, C, Komici, K, Paolillo, S, Fusco, F, Koch, WJ, 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, vol. 171, no. 3, pp. 384-389. https://doi.org/10.1016/j.ijcard.2013.12.024
Rengo, Giuseppe ; Pagano, Gennaro ; Parisi, Valentina ; Femminella, Grazia Daniela ; De Lucia, Claudio ; Liccardo, Daniela ; Cannavo, Alessandro ; Zincarelli, Carmela ; Komici, Klara ; Paolillo, Stefania ; Fusco, Flavia ; Koch, Walter J. ; Perrone Filardi, Pasquale ; Ferrara, Nicola ; Leosco, Dario. / Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure. In: International Journal of Cardiology. 2014 ; Vol. 171, No. 3. pp. 384-389.
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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.",
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T1 - Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure

AU - Rengo, Giuseppe

AU - Pagano, Gennaro

AU - Parisi, Valentina

AU - Femminella, Grazia Daniela

AU - De Lucia, Claudio

AU - Liccardo, Daniela

AU - Cannavo, Alessandro

AU - Zincarelli, Carmela

AU - Komici, Klara

AU - Paolillo, Stefania

AU - Fusco, Flavia

AU - Koch, Walter J.

AU - Perrone Filardi, Pasquale

AU - Ferrara, Nicola

AU - Leosco, Dario

PY - 2014/2/15

Y1 - 2014/2/15

N2 - 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.

AB - 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.

KW - Exercise training

KW - Heart failure

KW - N-terminal pro-brain natriuretic peptide

KW - Norepinephrine

KW - Prognosis

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