title: Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex-DHF pilot study.
abstract: BACKGROUND
  Over 50% of patients with symptomatic heart failure (HF) experience HF with preserved ejection fraction (HFpEF).Exercise training (ET) is effective in improving cardiorespiratory fitness and dimensions of quality of life in patients with HFpEF. A systemic pro-inflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations has been proposed in HFpEF. ET modifies myocardial structure and has been related to inflammatory state. We investigated Ghrelin, related adipokines, markers of inflammation, and neuro-hormonal activation in patients undergoing a structured ET vs. usual care are with HFpEF.
  
  
  RESULTS
  Ex-DHF-P was a prospective, controlled, randomized multi-centre trial on structured and supervised ET in patients with HFpEF. We performed apost hocanalysis in 62 patients from Ex-DHF-P. Ghrelin, adiponectin, leptin, IL-1ß, IL-6, IL-10, tumour necrosis factor-alpha, MR-proANP, MR-proADM, CT-proET1, and CT-proAVP were assessed to seize the impact of ET on these markers in patients with HFpEF. Thirty-six (58%) patients were female, mean age was 64 years, and median ghrelin was 928 pg/mL (interquartile range 755-1156). When stratified for high versus low ghrelin, groups significantly differed at baseline in presence obesity, waist circumference, and adiponectin levels (P< 0.05, respectively). Overall, ghrelin levels rose significantly to 1013 pg/mL (interquartile range 813-1182) (P< 0.001). Analysis of covariance modelling for change in ghrelin identified ET (P= 0.013) and higher baseline adiponectin levels (P= 0.035) as influencing factors.
  
  
  CONCLUSIONS
  Exercise training tended to increase ghrelin levels in Ex-DHF-P. This increase was especially pronounced in patients with higher baseline adiponectin levels. Future trials are needed to investigate the effect of ET on endogenous ghrelin levels in regard to interactions with cardiac structure and clinically meaningful surrogate parameters.
authors.affiliation: Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany.
authors.forename: Tobias Daniel
authors.identifier: 0000-0001-8575-0019
authors.initials: TD
authors.lastname: Trippel
authors.affiliation: ZKS Leipzig (Clinical Trial Centre Leipzig) University of Leipzig Leipzig Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Holzendorf
authors.affiliation: DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany.
authors.forename: Martin
authors.initials: M
authors.lastname: Halle
authors.affiliation: Institute for Clinical Epidemiology and BiometryUniversity of WürzburgWürzburgGermany; Clinical Trial CentreUniversity Hospital WürzburgWürzburgGermany.
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.affiliation: Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Nolte
authors.affiliation: DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany; Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany.
authors.forename: Andre
authors.initials: A
authors.lastname: Duvinage
authors.affiliation: DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany.
authors.forename: Silja
authors.initials: S
authors.lastname: Schwarz
authors.affiliation: Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany.
authors.forename: Tinka
authors.initials: T
authors.lastname: Rutscher
authors.affiliation: Department of Internal Medicine - Cardiology Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum Berlin Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Wiora
authors.affiliation: Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
authors.affiliation: DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany; Department for Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
authors.affiliation: Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany.
authors.forename: Hans-Dirk
authors.initials: HD
authors.lastname: Duengen
authors.affiliation: Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany.
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.affiliation: Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany; Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany.
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
keywords: Biomarkers; Exercise; Ghrelin; Heart failure; Training