title: C-type natriuretic peptide expression in patients with chronic heart failure: effects of aerobic training.
abstract: BACKGROUND
  C-type natriuretic peptide (CNP) is structurally related to cardiac natriuretic peptides and is currently considered as an endothelium-derived hyperpolarizing factor. Endothelial dysfunction, commonly observed in chronic heart failure (HF) patients is positively affected by physical training.
  
  
  METHODS
  To evaluate the effect of aerobic physical training on the expression of CNP, 90 HF patients on optimal pharmacological treatment (age 62+/-2 years, mean+/-SEM), randomly assigned in a 3 : 1 ratio to either control group (C, 19 patients) or home-based aerobic exercise-training program group (T, 71 patients), completed the protocol. Plasma assay of CNP, brain natriuretic peptide or B-type natriuretic peptide (BNP), and norepinephrine; echocardiogram; and cardiopulmonary-stress test were performed in all patients at enrollment and after 9 months.
  
  
  RESULTS
  At baseline, in both groups, CNP plasma level was significantly related to BNP (R=0.50), ejection fraction (R=0.43), and peak oxygen uptake (VO2, R=0.43, all P<0.001). After 9 months, trained patients showed an improvement in peak VO2 (P<0.001) and ejection fraction (P<0.05), whereas norepinephrine (P<0.05), BNP (P<0.001), and CNP (P<0.001) decreased. No changes occurred in group C. In group T, the decrease in CNP was significantly related to the increase in peak VO2 (R=0.31, P<0.01), and the relation between CNP and BNP was preserved at the end of the program (R=0.41, P<0.001).
  
  
  CONCLUSIONS
  Clinical and functional improvement after physical training in HF patients is associated with a decrease in adrenergic activation and in both CNP and BNP concentration. Changes in CNP plasma concentration after physical training might reflect an improvement in endothelial function.
authors.affiliation: Cardiovascular Medicine Department, CNR Institute of Clinical Physiology, Pisa, Italy. passino@ifc.cnr.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Silvia
authors.initials: S
authors.lastname: Del Ry
authors.forename: Silvia
authors.initials: S
authors.lastname: Severino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gabutti
authors.forename: Concetta
authors.initials: C
authors.lastname: Prontera
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
authors.forename: Daniela
authors.initials: D
authors.lastname: Giannessi
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
mesh_terms: D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015536:Down-Regulation; D004452:Echocardiography; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020098:Natriuretic Peptide, C-Type / Q000097:blood*; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type; D009638:Norepinephrine