Influence of cardiac rehabilitation on natriuretic peptides.
OBJECTIVE
Cardiac rehabilitation programmes result in reduced morbidity and mortality and improvement of functional class. Behaviour of natriuretic peptides coupled to these programmes is not well established. Our study's objective is to evaluate the behaviour of natriuretic peptides in a sample of patients undergoing a cardiac rehabilitation programme.


RESULTS
Moderate to high-risk patients undergoing a cardiac rehabilitation programme were included. Demographic and clinical characteristics were recorded. We performed four N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma determinations: on the first and last programme day, before and after training. To evaluate functional capacity, a stress test before and after the exercise programme was performed. Eighty-three patients were included. Exercise produces increased levels of NT-proBNP, although in the last exercise session the increase was lower (35.91 vs. 31.49 ng/ml (P = 0.71)). Patients with left ventricular dysfunction present higher NT-proBNP levels. After the rehabilitation programme we observed a significant improvement of functional capacity by 1.5 METS on average (P = 0.001), but not in the subgroup with lower NT-proBNP levels.


CONCLUSIONS
Basal levels of peptides did not change significantly after the programme but rose with the workout, especially in patients with left ventricular dysfunction. Patients with higher baseline levels obtained greater functional recovery. We conclude that NT-proBNP measurement may be useful in selecting patients to perform a cardiac rehabilitation programme.
Cardiology Department, Hospital Clinico Universitario Virgen de la Victoria, Malaga, Spain.
Angel
A
Montiel-Trujillo
Guillermo
G
Isasti-Aizpurua
Fernando
F
Carrasco-Chinchilla
Manuel F
MF
Jiménez-Navarro
Adela
A
Gómez-González
José C
JC
Bravo Navas
Cristina
C
Jimeno
Eduardo
E
De Teresa-Galván
D054058:Acute Coronary Syndrome / Q000097:blood / Q000534:rehabilitation*; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018579:Patient Selection; D010446:Peptide Fragments / Q000097:blood*; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000534:rehabilitation*
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain