N-terminal pro-atrial natriuretic peptide and exercise prescription in patients with myocardial infarction.
BACKGROUND
Left ventricular end-diastolic pressure (LVEDP) during exercise workload is an important parameter to guide an exercise prescription for patients with cardiovascular disease. Plasma levels of neuro-hormonal factors can be used as a reflection of real-time LVEDP, but its utility is limited by its short half-life. By contrast, the N-terminal fragment of pro-ANP (NT-ANP) has a longer half-life of 1 h.


OBJECTIVE
To determine whether plasma NT-ANP levels at 30 min after exercise can be used as a marker of LVEDP during peak exercise workload in patients with previous myocardial infarction.


METHODS
Twenty patients with a previous history of myocardial infarction.


METHODS
Cardiopulmonary exercise test was performed to determine peak VO(2) and anaerobic threshold. Plasma levels of ANP, BNP, NT-ANP, vasopressin and plasma catecholamine were measured at rest, maximum exercise, and 30 min after exercise (recovery).


RESULTS
With the exception of NT-ANP, the levels of each of neuro-hormonal factors peaked at maximum exercise and returned to baseline at recovery. By contrast, NT-ANP levels also increased at peak exercise but remained elevated at 30 min after exercise. Furthermore, NT-ANP levels at recovery correlated with ANP levels at maximum exercise (p<0.01, R=0.75), left ventricular ejection fraction (p<0.02, R=-0.54) and left ventricular systolic dimension (p<0.015, R=0.50).


CONCLUSIONS
Plasma NT-ANP levels at 30 min after exercise reflect ANP levels at maximum exercise and left ventricular overload during exercise. These data indicate that plasma NT-ANP after exercise may be a useful parameter to guide prescription of cardiac rehabilitation.
Ikeda
Nahoko
N
Cardiovascular Division, Department of Integrated Medicine I, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma, Saitama, Saitama 330-8503, Japan.
Yasu
Takanori
T
Nishikimi
Toshio
T
Nakamura
Tomohiro
T
Kubo
Norifumi
N
Kawakami
Masanobu
M
Momomura
Shin-ichi
S
Saito
Muneyasu
M
D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001794:Blood Pressure; D002395:Catecholamines / Q000097:blood; D015444:Exercise; D005260:Female; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D013997:Time Factors; D014667:Vasopressins / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000534:rehabilitation*
D002395:Catecholamines; D010446:Peptide Fragments; D011498:Protein Precursors; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor