Maeder Micha, Wolber Thomas, Rickli Hans, Myers Jonathan, Hack Dietrich, Riesen Walter, Weilenmann Daniel, Ammann Peter
Division of Cardiology, Department of Internal Medicine, Kantonsspital St. Gallen, Switzerland.
Int J Cardiol. 2007 Sep 3;120(3):391-8. doi: 10.1016/j.ijcard.2006.10.016. Epub 2006 Dec 19.
In patients with chronic heart failure (CHF), B-type natriuretic peptide (BNP) is related to peak oxygen consumption (peak VO2) and the relationship between minute ventilation and carbon dioxide production (VE/VCO2 slope). However, the exercise response depends on the mode of exercise. This study sought to compare peak treadmill and bicycle exercise responses with respect to their relationship with BNP and to assess whether BNP measured at rest or during exercise could identify patients with greater functional impairment and ventilatory inefficiency.
Twenty-three patients with mild-to-moderate stable systolic CHF (age 72+/-8 years, left ventricular ejection fraction 32+/-7%) underwent treadmill and bicycle cardiopulmonary exercise testing within 5 (interquartile range 3-7) days. BNP was measured at rest and at peak exercise.
BNP at rest was an independent multivariate predictor of both peak VO2 and the VE/VCO2 slope for both exercise modes. However, the proportion of variance explained univariately and multivariately was < or = 0.55, indicating that BNP did not strongly explain the variation of peak VO2 and the VE/VCO2 slope. The exercise-induced rise in circulating BNP did not differ between the test modes [treadmill: 50 (24-89) pg/ml vs. bicycle: 46 (15-100) pg/ml; p=0.73]. BNP levels at peak exercise were strongly related to resting values, but did not provide additional information on peak VO2 or the VE/VCO2 slope.
In typical CHF patients, BNP measured at rest or at peak exercise does not strongly predict peak VO2 or the VE/VCO2 slope regardless of the exercise mode, and is therefore not a sufficiently accurate surrogate for cardiopulmonary exercise testing.
在慢性心力衰竭（CHF）患者中，B型利钠肽（BNP）与峰值耗氧量（峰值VO₂）以及分钟通气量与二氧化碳产生量的关系（VE/VCO₂斜率）相关。然而，运动反应取决于运动模式。本研究旨在比较跑步机运动和自行车运动的峰值反应与BNP的关系，并评估静息或运动时测量的BNP是否能识别出功能损害更严重和通气效率低下的患者。
23例轻度至中度稳定收缩性CHF患者（年龄72±8岁，左心室射血分数32±7%）在5（四分位间距3 - 7）天内进行了跑步机和自行车心肺运动测试。在静息和运动峰值时测量BNP。
静息时的BNP是两种运动模式下峰值VO₂和VE/VCO₂斜率的独立多变量预测因子。然而，单变量和多变量解释的方差比例≤0.55，表明BNP并不能有力地解释峰值VO₂和VE/VCO₂斜率的变化。两种测试模式下运动诱导的循环BNP升高无差异[跑步机：50（24 - 89）pg/ml对自行车：46（15 - 100）pg/ml；p = 0.73]。运动峰值时的BNP水平与静息值密切相关，但未提供关于峰值VO₂或VE/VCO₂斜率的额外信息。
在典型的CHF患者中，无论运动模式如何，静息或运动峰值时测量的BNP都不能有力地预测峰值VO₂或VE/VCO₂斜率，因此不是心肺运动测试的足够准确的替代指标。
