The effects of early exercise on cardiovascular biomarkers in patients with congestive heart failure.

BACKGROUND

Exercise training improves functional outcomes in chronic heart failure (HF), but the effects of early in-hospital physical activity on cardiovascular biomarkers and prognosis in acute congestive heart failure (AHF) patients remain unclear. This study investigated the short-term impact of early rehabilitation on prognostic biomarkers-high-sensitivity troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble suppression of tumourigenesis-2 (sST2), galectin-3 (Gal-3) and endothelin-1 (ET-1)-and evaluated associations with clinical outcomes.

METHODS AND RESULTS

A total of 118 hospitalized AHF patients (35 controls and 83 exercise group) underwent biomarker measurement before and after supervised rehabilitation using non-invasive cardiac output monitoring. Serum levels of NT-proBNP, hs-TnT, sST2, Gal-3, and ET-1 were analysed. Prognosis was assessed via 12-month follow-up for all-cause mortality. Statistical analysis included ANOVA for biomarker changes and Kaplan-Meier survival analysis. Post-intervention, NT-proBNP levels increased significantly in the exercise group (2900 ± 700 pg/mL to 3500 ± 760 pg/mL, P = 0.012), as did ET-1 (1.9 ± 0.4 pg/mL to 2.4 ± 0.5 pg/mL, P = 0.018). Hs-TnT, sST2 and Gal-3 showed no significant changes (all P > 0.05). Survival analysis demonstrated higher baseline hs-TnT [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.3-3.4] and greater NT-proBNP elevation post-exercise (ΔNT-proBNP HR 1.8, 95% CI 1.1-2.9) were independent predictors of mortality.

CONCLUSIONS

Early in-hospital exercise in AHF patients transiently elevates NT-proBNP and ET-1, indicative of acute haemodynamic stress, without altering myocardial injury or fibrosis markers (hs-TnT, sST2 and Gal-3). Elevated baseline hs-TnT and post-exercise NT-proBNP increases correlate with poorer survival, highlighting their prognostic value in risk assessment.