Brain natriuretic peptide kinetics during dynamic exercise in patients with chronic heart failure

Background: The kinetics of brain natriuretic peptide (BNP) secretion in chronic heart failure (CHF) during dynamic exercise have been the subject of controversial debate. The present study was therefore aimed to further clarify whether marked changes in BNP levels occur during and directly after vigorous exercise in CHF patients. Methods: We prospectively studied 37 patients with CHF (60±10 years, LVEF 26±6%) and 20 healthy controls (58±11 years, LVEF 60±3%). Standardized exercise testing was performed in all CHF patients and controls. Venous blood samples for measurement of BNP were obtained prior to symptom-limited exercise, at peak exercise and at 1 and 5 min of recovery time. Results: BNP concentrations were significantly higher in CHF compared to controls at rest, peak exercise and at 1 and 5 min of recovery. BNP levels did not change significantly during exercise in the control group. In CHF patients, BNP levels showed no marked difference at rest (428±421 pg/ml), peak exercise (507±450 pg/ml, n.s.), 1 min (560±460 pg/ml, n.s.) and 5 min recovery (526±424 pg/ml, n.s.). Strikingly, 6 of 37 CHF patients (16%) showed a decrease in BNP at exercise compared to rest but none of the controls. Conclusions: BNP levels in CHF patients and healthy controls are not significantly altered by vigorous exercise. In contrast to controls, 16% of CHF patients showed a decrease in BNP levels at exercise. In CHF, BNP levels were inversely correlated with peak VO2, VO2-AT and LVEF.