Relationship Between Exercise Capacity and Brain Natriuretic Peptide in Patients After Cardiac Surgery

Transcription

1 Relationship Between Exercise Capacity and Brain Natriuretic Peptide in Patients After Cardiac Surgery Yoshihiro J. Akira Kazuto Naohiko Tomoko Akihiko Keiko Tadanori AKASHI, MD KOIKE, MD, FJCC OMIYA, MD OSADA, MD MAEDA TAJIMA OIKAWA, MD AIZAWA, MD, FJCC Hiroyuki Long-Tai IINUMA, MD FU, MD Abstract Objectives. Physical training in cardiac patients can increase exercise capacity and reduce plasma brain natriuretic peptide BNP concentration, but these effects may depend on the etiology of cardiac disease. The change in exercise capacity and BNP during the training period were investigated in patients with different cardiac diseases. Methods. Ninety-one patients after coronary artery bypass grafting CABG and 78 patients after valve replacement VR underwent a symptom-limited incremental cardiopulmonary exercise test before 1 month and 6 months after physical training. Anaerobic threshold and peak oxygen uptake peak-vo 2 were measured during the cardiopulmonary exercise test. Before each cardiopulmonary exercise test, a blood sample was obtained in the resting condition for measuring BNP. Results. Anaerobic threshold and peak-vo 2 were increased significantly from 1 month to 6 months in both groups. BNP in the CABG group indicated a tendency to decrease pg/ml, p 0.1 from 1 month to 6 months. BNP in VR group was significantly decreased pg/ml, p 0.05 during the training period. The CABG group showed a significant negative correlation between peak-vo 2 and BNP at 1 month r0.28, p 0.01 and at 6 months r 0.39, p The VR group showed a significant negative correlation between peak-vo 2 and BNP at 6 months r0.32, p 0.01, but not at 1 month. Conclusions. Six months of physical training in patients after cardiac surgery may improve exercise capacity and reduce BNP. BNP concentration in the VR group before physical training did not reflect functional capacity. J Cardiol 2003 Aug ; 42 2 : Key Words Cardiac surgery CABG, valve replacement Exercise capacity Rehabilitation cardiac Natriuretic peptide, brain : ; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki ; Department of Internal Medicine, The Cardiovascular Institute Hospital, Tokyo Address for correspondence : AKASHI, YJ, MD, Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao , Miyamae-ku, Kawasaki Manuscript received February 14, 2003 ; revised March 27, 2003; accepted April 9,

2 68 1 MET 10% 1 3 Myers 3 coronary artery bypass grafting : CABG 14.1% 3,679 Na brain natriuretic peptide: BNP BNP 5,10,11 10,11 8 BNP 12,13 14 BNP CABG BNP CABG Table Med Graphics CPE Linkar- Mason stress system ML-5000 STBP W 4 1W/6sec ramp W breath by breath AE-280 / V-slope 15 2 Na 30 4 C 3,000 rpm C 3 BNP 2 Shionoria BNP 3 Hewlett Packard SONOS

3 Na 69 Table 1 Patient characteristics CABG group VR group p value Number of patients Male Female Age yr Height cm Weight kg Body surface area m 2 Cardiac function and exercise capacity Left ventricular ejection fraction % Anaerobic threshold ml/kg/min Peak oxygen uptake ml/kg/min Peak heart rate beats/min Training heart rate beats/min Rest BNP pg/ml Basic cardiac disease One-vessel disease Two-vessel disease Three-vessel disease MS, MR, MSR AS, AR, ASR Double valve disease Triple valve disease Medication ACE-I or A- Diuretics Digoxine Nitrate Calcium channel blocker Beta-blocker Anticoagulant Continuous values are mean SD. CABG coronary artery bypass grafting ; VR valve replacement ; BNP brain natriuretic peptide ; MS mitral stenosis ; MR mitral regurgitation ; MSR mitral stenosis and regurgitation ; AS aortic stenosis ; AR aortic regurgitation ; ASR aortic stenosis and regurgitation ; ACE-I angiotensin converting enzyme inhibitor ; A- angiotensin receptor antagonist. 5 2 Fisher PLSDp Table Table CABG

4 70 Table 2 Systolic and diastolic blood pressure, heart rate, oxygen uptake and other parameters 1M CABG group VR group 6M p value 1M 6M p value Systolic blood pressure mmhg Rest Warm-up Anaerobic threshold Peak Diastolic blood pressure mmhg Rest Warm-up Anaerobic threshold Peak Heart rate beats/min Rest Warm-up Anaerobic threshold Peak Oxygen uptake ml/min/kg Rest Warm-up Anaerobic threshold Peak Other parameters Body weight kg VO 2 / WR ml/min/kg/w VE/VCO BNP pg/ml Values are mean SD. 1M vs 6M. 1M 1-month ; 6M 6-month ; VO 2 oxygen uptake ; WR work rate ; VE minutes ventilation ; VCO 2 carbon dioxide output. Other abbreviations as in Table mmHg mmhg mmHg mmHg 6 CABG mmHg mmHg mmHg mmhg 1 6 CABG 2 1 CABG /min /min /min /min 6 CABG /min /min

5 Na 71 Fig. 1 Relationship between peak oxygen uptake and plasma brain natriuretic peptide in patients after coronary artery bypass graft There are significant negative correlations at both 1 month and 6 months after the surgery. Abbreviations as in Tables 1, /min /min 1 6 CABG 3 1 CABG ml/min/kg ml/min/kg 6 CABG ml/min/kg ml/min/kg1 4 1 / work rate CABG ml/min/kg/W ml/min/kg/w /CABG Na 1 BNP CABG pg/ml pg/ml 1 6 BNPp 0.05CABG p Na CABG BNP 1 r 0.28 p r 0.39 p Fig r 0.32 p 0.01 Fig. 2 BNP BNP 6 CABG

6 72 Fig. 2 Relationship between peak oxygen uptake and plasma brain natriuretic peptide in patients after valve replacement There is a significant negative correlation only at 6 months after the surgery. Abbreviations as in Tables 1, 2. CABG BNP Mair 12 BNP BNP BNPCABG 16 BNP BNPCABG CABG / BNP CABG CABG 1 CABG 2 Murabayashi 17 BNP Fujinaga 14 1 BNP BNP 6 BNP BNP BNP BNP

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