Left ventricular remodelling in patients with moderate systolic dysfunction after myocardial infarction: favourable effects of exercise training and predictive role of N-terminal pro-brain natriuretic peptide.
OBJECTIVE
To investigate the effects of exercise training (ET) on left ventricular (LV) volumes, cardiopulmonary functional capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in postinfarction patients with moderate LV dysfunction.


METHODS
Sixty-one postinfarction patients were randomized into two groups: group T [n=30, LV ejection fraction (EF) 41.6+/-11.3%, mean+/-SD] entered a 6-month ET programme, whereas group C (n=31, EF 42.0+/-7.6%, P=NS) did not. NT-proBNP assay, Doppler-echocardiography and cardiopulmonary exercise test were performed upon enrolment and at sixth months.


RESULTS
At sixth months, trained patients showed an improvement in workload (+26%, P<0.001), Vo2peak (+31%, P<0.001), LV end-diastolic volume index (LVEDVI; -9%, P<0.001), a reduction in NT-proBNP (-71%, P<0.001) and a significant correlation between changes in NT-proBNP and in LVEDVI (r=0.858, P<0.001). Baseline NT-proBNP correlated with changes in LVEDVI in both trained (r=0.673, P<0.001) and untrained (r=0.623, P<0.001) patients. Group C showed unfavourable LVEDVI dilation (+8%, P<0.001; T vs. C group, P<0.001) and a smaller reduction in NT-proBNP (-40%, P<0.001; T vs. C group, P<0.001).


CONCLUSIONS
Six month ET induced a favourable LV remodelling and a marked fall in NT-proBNP that could predict LV remodelling in postinfarction patients with moderate LV dysfunction.
Giallauria
Francesco
F
Cardiac Rehabilitation Unit , Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Naples, Italy. giallauria@libero.it
Cirillo
Plinio
P
Lucci
Rosa
R
Pacileo
Mario
M
De Lorenzo
Anna
A
D'Agostino
Mariantonietta
M
Moschella
Sabino
S
Psaroudaki
Marianna
M
Del Forno
Domenico
D
Orio
Francesco
F
Vitale
Dino Franco
DF
Chiariello
Massimo
M
Vigorito
Carlo
C
D015150:Echocardiography, Doppler; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000534:rehabilitation*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000534:rehabilitation*; D020257:Ventricular Remodeling
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain