RESPONSES OF ATRIAL-NATRIURETIC-PEPTIDE AND BRAIN NATRIURETIC PEPTIDETO EXERCISE IN PATIENTS WITH CHRONIC HEART-FAILURE AND NORMAL CONTROLSUBJECTS

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) a re known to be elevated in patients with chronic heart failure at rest . While it is known that during exercise the circulating level of ANP increases in patients with heart failure, the response of BNP to exerc ise in these patients relative to control subjects is unclear. Ten pat ients with stable chronic heart failure and 10 normal control subjects performed symptom-limited exercise with respired gas analysis. All pa tients had depressed left ventricular ejection fractions (LVEF). Patie nts had lower peak oxygen consumption PVo(2)) than the central group [ median (range) 1.18 (0.98 - 1.76) vs. 1.94 (1.53-2.31)L min(-1); P < 0 .001]. Circulating plasma levels of ANP and BNP were higher at rest in patients than in control subjects [ANP 335 (140-700) vs. 90 (25-500) pg mL(-1); BNP 42 (25-50) vs. 20 (10-20) pg mL(-1)], and at peak exerc ise [ANP 400 (200-1000) vs. 130 (10-590); BNP 46 (40-51) vs. 20 (10-30 )]. The rise in ANP at peak exercise was significant in patients compa red with the resting level, but not in control subjects. For BNP, ther e was a significant rise in patients but no change in control subjects . The circulating plasma levels of both peptides showed a strong negat ive correlation with LVEF (ANP, P < 0.005; BNP, P < 0.0001) and, to a less extent, with RVEF. It is possible that BNP may give a better indi cation of cardiac function.