Scharhag Jürgen, Herrmann Markus, Weissinger Melanie, Herrmann Wolfgang, Kindermann Wilfried
Institut für Sport- und Präventivmedizin, Fachbereich Klinische Medizin, Universität des Saarlandes, Saarbrücken, Germany.
Clin Res Cardiol. 2007 Apr;96(4):218-26. doi: 10.1007/s00392-007-0491-2. Epub 2007 Feb 26.
Elevated concentrations of B-type natriuretic peptide (BNP) and N-terminal pro- BNP (NT-proBNP) reflect elevated myocardial wall stress due to volume or pressure overload in cardiac disease. Recently, exercise-induced elevations of (NT-pro)BNP in coronary artery disease (CAD) patients have been reported to result from exercise-induced ischemia associated regional wall abnormalities. Therefore, the study aimed to examine NT-proBNP concentrations in patients with CAD after moderate and brisk walking (MW, BW). We hypothesized that BW induces higher increases than MW.
In randomized order 14 patients with stable CAD (12 male symbol/2 female symbol; 63 +/- 9 years; LV ejection fraction: 59+/-9%) of a out-patient rehabilitation group performed MW with 4.5 +/- 0.6 km/h (mean heart rate: 80 +/- 11/min) or BWat their allowed upper exercise heart rate of 102+/-9/min with a speed of 6.2 +/- 0.6 km/h for 30 min on a tartan track on two separate days. Blood samples were taken before, immediately, 1 h, 3 h and 1 day after exercise to determine NT-proBNP and cardiac troponin T (cTnT). Echocardiographic LV function was determined before and 1 h after exercise. Median concentrations of NT-proBNP significantly increased from 222 to 295 ng/l (MW) and from 222 to 296 ng/l (BW) without a difference between both modalities. cTnT remained below the detection limit of 0.01 microg/l. LV functions remained unchanged. A cutoff level of 250 ng/l distinguished CAD patients with elevated exercise-induced increases in NT-proBNP and a diminished LV ejection fraction at rest.
BW and MW induce similar increases in NT-proBNP in CAD patients without myocardial damage, which have to be considered when NT-proBNP is determined. Derived from the exercise- induced increase in NTproBNP, the myocardial strain in BW is not elevated in comparison to MW.
B型利钠肽（BNP）和N末端前脑钠肽（NT-proBNP）浓度升高反映了由于心脏病中的容量或压力过载导致的心肌壁应力升高。最近，有报道称冠状动脉疾病（CAD）患者运动诱导的（NT-pro）BNP升高是由运动诱导的缺血相关区域壁异常引起的。因此，本研究旨在检测中度步行（MW）和轻快步行（BW）后CAD患者的NT-proBNP浓度。我们假设BW比MW引起的升高更高。
门诊康复组的14例稳定CAD患者（12例男性/2例女性；63±9岁；左心室射血分数：59±9%）以随机顺序在两天内分别在一条柏油跑道上以4.5±0.6公里/小时（平均心率：80±11次/分钟）进行MW或在其允许的最高运动心率102±9次/分钟、速度6.2±0.6公里/小时下进行BW，持续30分钟。在运动前、运动后即刻、1小时、3小时和1天后采集血样以测定NT-proBNP和心肌肌钙蛋白T（cTnT）。在运动前和运动后1小时测定超声心动图左心室功能。NT-proBNP的中位数浓度从222显著增加到295纳克/升（MW）和从222增加到296纳克/升（BW），两种方式之间无差异。cTnT仍低于检测限0.01微克/升。左心室功能保持不变。250纳克/升的临界值可区分运动诱导的NT-proBNP升高且静息时左心室射血分数降低的CAD患者。
在无心肌损伤的CAD患者中，BW和MW诱导的NT-proBNP升高相似，在测定NT-proBNP时必须考虑这一点。从运动诱导的NT-proBNP升高来看，与MW相比，BW中的心肌应变并未升高。
