Giallauria Francesco, De Lorenzo Anna, Pilerci Francesco, Manakos Athanasio, Lucci Rosa, Psaroudaki Marianna, D'Agostino Mariantonietta, Del Forno Domenico, Vigorito Carlo
Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Italy.
Eur J Cardiovasc Prev Rehabil. 2006 Aug;13(4):625-32. doi: 10.1097/01.hjr.0000209810.59831.f4.
N-terminal-pro-brain (B-type) natriuretic peptide (NT-pro-BNP) is a peptide hormone released from ventricles in response to myocyte stretch. The aim of the study was to investigate the influence of exercise training on plasma NT-pro-BNP to verify if this parameter could be used as a biological marker of left ventricular remodelling in myocardial infarction patients undergoing an exercise training programme.
Forty-four patients after myocardial infarction were enrolled into a cardiac rehabilitation programme, and were randomized in two groups of 22 patients each. Group A patients followed a 3-month exercise training programme, while group B patients received only routine recommendations. All patients underwent NT-pro-BNP assay, and cardiopulmonary exercise test before hospital discharge and after 3 months.
In Group A, exercise training reduced NT-pro-BNP levels (from 1498+/-438 to 470+/-375 pg/ml, P=0.0026), increased maximal (VO2peak+4.3+/-2.9 ml/kg per min, P<0.001; Powermax+38+/-7, P<0.001) exercise parameters and work efficiency (Powermax/VO2peak+1.3+/-0.4 Power/ml per kg per min, P<0.001); there was also an inverse correlation between changes in NT-pro-BNP levels and in VO2peak (r=-0.72, P<0.001), E-wave (r=-0.51, P<0.001) and E/A ratio (r=0.59, P<0.001). In group B, at 3 months, no changes were observed in NT-pro-BNP levels, exercise and echocardiographic parameters.
Three months exercise training in patients with moderate left ventricular systolic dysfunction after myocardial infarction induced a reduction in NT-pro-BNP levels, an improvement of exercise capacity and early left ventricular diastolic filling, without negative left ventricular remodelling. Whether the reduction of NT-pro-BNP levels could be useful as a surrogate marker of favourable left ventricular remodelling at a later follow-up remains to be further explored.
N 端前脑钠肽（B 型）（NT-pro-BNP）是一种心室在心肌细胞受牵拉时释放的肽类激素。本研究旨在探讨运动训练对血浆 NT-pro-BNP 的影响，以验证该参数是否可作为接受运动训练计划的心肌梗死患者左心室重构的生物学标志物。
44 例心肌梗死后患者纳入心脏康复计划，并随机分为两组，每组 22 例。A 组患者进行为期 三个月的运动训练计划，而 B 组患者仅接受常规建议。所有患者在出院前和三个月后均接受 NT-pro-BNP 检测和心肺运动试验。
在 A 组中，运动训练降低了 NT-pro-BNP 水平（从 1498±438 降至 470±375 pg/ml，P = 0.0026），增加了最大运动参数（峰值摄氧量增加 4.3±2.9 ml/kg 每分钟，P < 0.001；最大功率增加 38±7，P < 0.001）和工作效率（最大功率/峰值摄氧量增加 1.3±0.4 功率/ml/kg 每分钟，P < 0.001）；NT-pro-BNP 水平变化与峰值摄氧量变化（r = -0.72，P < 0.001）、E 波（r = -0.51，P < 0.001）和 E/A 比值（r = 0.59，P < 0.001）之间也存在负相关。在 B 组中，三个月时，NT-pro-BNP 水平、运动和超声心动图参数均未观察到变化。
心肌梗死后中度左心室收缩功能障碍患者进行三个月运动训练可降低 NT-pro-BNP 水平，改善运动能力和早期左心室舒张期充盈，且无不良左心室重构。NT-pro-BNP 水平降低是否可作为后期随访中左心室良好重构的替代标志物仍有待进一步探索。
