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Absence of BNP decrease after exercise therapy in chronic heart failure patients with chronic atrial fibrillation: comparison with sinus rhythm

Session Poster session 4

Speaker Ayumi Date

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : A Date (Osaka,JP), T Tokeshi (Osaka,JP), H Miura (Osaka,JP), R Kumasaka (Osaka,JP), K Nakao (Osaka,JP), T Arakawa (Osaka,JP), S Fukui (Osaka,JP), T Hasegawa (Osaka,JP), M Nakanishi (Osaka,JP), M Yanase (Osaka,JP), T Noguchi (Osaka,JP), T Anzai (Osaka,JP), S Yasuda (Osaka,JP), Y Goto (Osaka,JP)

A. Date1 , T. Tokeshi1 , H. Miura1 , R. Kumasaka1 , K. Nakao1 , T. Arakawa1 , S. Fukui1 , T. Hasegawa1 , M. Nakanishi1 , M. Yanase1 , T. Noguchi1 , T. Anzai1 , S. Yasuda1 , Y. Goto1 , 1National Cerebral and Cardiovascular Center Hospital, Cardiovascular Medicine - Osaka - Japan ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 714

Background: Chronic atrial fibrillation (AF) is known to be associated with elevated plasma B-type natriuretic peptide (BNP) levels. Although exercise-based cardiac rehabilitation (ECR) is known to increase exercise capacity (peak oxygen uptake, PVO2) and decrease plasma BNP in patients with chronic heart failure with sinus rhythm (CHF-SR), it remains unknown whether ECR is also effective in increasing PVO2 and decreasing BNP in CHF patients with chronic AF (CHF-AF).

Objective: Accordingly, we assessed PVO2 and BNP before and after ECR in CHF-AF and CHF-SR patients.

Methods: We screened 365 consecutive hospitalized CHF patients who entered our 3-month ECR program. ECR program consisted of supervised aerobic exercise training (walking and/or cycle ergometer) and patient education. All patients underwent blood sampling and symptom-limited cardiopulmonary exercise testing (CPX, measurements for PVO2) at the beginning and the end of ECR, and received exercise prescription (training HR or Borg scale) after the initial CPX (at 2nd or 3rd week) and continued outpatient ECR for 3 months. Patients with insufficient outpatient ECR session attendance (less than once a week, n=117) or with electrical device implantation (n=59) or paroxysmal AF (n=32) were excluded, and the remaining 157 patients were divided into CHF-AF (n=29) and CHF-SR (n=128) group.

Results: At baseline, CHF-AF group, compared to CHF-SR group, had similar age (AF 64 vs SR 62y, NS), left ventricular ejection fraction (LVEF, 33 vs 28%, NS), baseline BNP levels (233 vs 182pg/ml, NS) and PVO2 (17.5 vs 18.8ml/kg/min, NS), but had significantly higher peak exercise HR (152 vs 132bpm, p<0.01) and higher VE/VCO2 slope (34 vs 32, P=0.04) in CPX and larger left atrium diameter (LADs, 52 vs 43mm, p<0.01). During ECR, CHF-AF group had lower exercise intensity (%peak work rate: 38 vs 45%, P<0.01) than CHF-SR group, while the number of outpatient session attendance (13 vs 14 times, NS) was similar. After 3-month ECR, in CHF-SR group, PVO2 increased by 11% (p<0.001) and BNP decreased by 26% (p<0.001), resulting in a significant inverse correlation between these two variables (r=-0.29, p<0.001). However, in CHF-AF group, although PVO2 increased by 10% (p<0.001), BNP did not decrease (+5%, NS), and no correlation between changes in PVO2 and BNP was seen (r=0.16, NS). In CHF-AF group, higher age, higher rest HR and higher systolic blood pressure were associated with poor decrease in BNP.

Conclusion: In CHF-AF patients, BNP did not decrease after ECR despite the significant increase in PVO2 with a similar magnitude to CHF-SR. This suggests that the effect of ECR on BNP decrease may be different between CHF-AF and CHF-SR.

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