Clinical study: diagnostics and heart failure
brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure

https://doi.org/10.1016/S0735-1097(02)02032-6Get rights and content
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Abstract

Objectives

The goal of this study was to determine if brain natriuretic peptide (BNP) levels are associated with exercise capacity in patients with chronic heart failure (HF).

Background

Plasma levels of BNP are increased subject to the degree of systolic and diastolic left ventricular dysfunction in patients with chronic HF. Exercise testing is useful to assess functional capacity and prognosis in chronic HF.

Methods

We prospectively studied 70 consecutive patients with chronic HF (60.3 ± 10.4 years, 51 men) referred for cardiopulmonary exercise testing. Resting BNP was obtained after 10 min of supine rest before symptom-limited bicycle exercise testing.

Results

In patients with chronic HF, BNP levels correlated with oxygen uptake (VO2), both at anaerobic threshold (VO2AT: r = −0.54, p < 0.001) and peak exercise (peak VO2: r = −0.56, p < 0.001). Impairment of ventilatory efficiency (EqCO2: r = 0.43, p < 0.001) and maximum exercise level (W % predicted: r = −0.44, p < 0.05) correlated less well with BNP. There was a significant inverse correlation between left ventricular ejection fraction and BNP (r = −0.50, p < 0.05). Brain natriuretic peptide discriminated well chronic HF patients with a peak VO2 <10 ml/min/kg (area under the receiver operating characteristic [ROC] 0.93) or <14 ml/min/kg (area under the ROC 0.72). A BNP >316 pg/ml was associated with a risk ratio of 6.8 (95% confidence interval, 2.3 to 19.8) for a reduced exercise capacity with a peak VO2 <14 ml/min/kg.

Conclusions

Brain natriuretic peptide is clearly associated with exercise capacity in chronic HF. Brain natriuretic peptide levels show a significant correlation with the impairment of VO2 at peak exercise and anaerobic threshold. Brain natriuretic peptide is able to differentiate between chronic HF patients with moderately and severely impaired exercise capacity.

Abbreviations

AT
anaerobic threshold
AUROC
area under the receiver operating characteristic curve
BNP
brain natriuretic peptide
CI
confidence interval
EqCO2
ventilatory efficiency
HF
heart failure
LVEF
left ventricular ejection fraction
VO2
oxygen uptake

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Guest Editor: Gottlieb Friesinger, II, MD.