Augmented response in plasma atrial natriuretic peptide to dynamic exercise in patients with congestive heart failure

Abstract

Neurohormonal activation in present and neurohormonal responses to dynamic exercise are altered in patients with congestive heart failure (CHF). The main of this study was to determine if the responses of atrial natriuretic peptide (ANP) normalized for peak oxygen consumption (peak V̇O2) to exercise are augmented in patients with CHF (NYHA classes II: 16, III; 12), 17 patients in NYHA class I, and 14 normal subjects during symptom- limited cardiopulmonary exercise testing. Plasma ANP was measured at rest and immediately after peak exercise. The increase in ANP was divided by peak V̇O2 and this ration [ANP-Exercise Ration: (peak ANP-rest ANP)/peak V̇O2] was compared among the 3 groups. Peak V̇O2 (Normal, NYHA I, CHF: 29.9 ± 1.7, 2.4 ± 1.3, 17.4 ± 0.8 ml/min per kg), anaerobic threshold and peak work rate were lower in patients with CHF. The resting ANP level was significantly higher in patients with CHF (Normal, NYHA I, CHF: 35.4 ± 4.6, 42.9 ± 5.8, 80.8 ± 12.9 pg/ml). The ANP level increased during exercise in all 3 groups, and patients with CHF had a significantly higher ANP level than normal subjects and NYHA class I patients (Normal, NYHA I, CHF: 65.3 ± H) 7, 75.9 ± 14.4, 141.6 ± 20.1 pg/ml). The ANP-Exercise Ratio in patients with CHF was significantly higher than those in normal subjects and NYHA class I patients with CHF but not those in NYHA class I have an augmented ANP response, as reflected by both absolute ANP levels and by the exercise ratio, which was normalized by the peak exercise level.