Changes of plasma norepinephrine and serum N-terminal pro-brain natriuretic peptide after exercise training predict survival in patients with heart failure

Background: Short-term changes of neurohormones can give important prognostic information in heart failure (HF) patients. In this study, we evaluate whether changes in plasma Norepinephrine (NE) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) after exercise training predict cardiac mortality in HF patients. Methods and results: Weenrolled 221 HF patients (mean age 72.5 +/- 10.2 year) followed-up for a mean period of 27.64 +/- 10.7 months. All pts underwent a 3-month exercise training. Before training, clinical examination, echocardiography, peak VO2 determination, and blood draw for NT-proBNP and NE measurements were performed. Primary end-pointwas cardiac relatedmortality. Eighty-six-nine percent of patientswere inNYHA class III, mean left ventricular ejection fraction (LVEF) was 32.5 +/- 10.4%, and mean peak VO2 was 12.36 +/- 1.45 ml/kg/min. At baseline, mean NT-proBNP was 2111.4 +/- 1145.6 pg/ml and mean NE was 641.8 +/- 215.3 pg/ml. One hundredone subjects died for cardiac causes. Training was associated with a significant increase of peak VO2 and LVEF, whereas NE, NT-proBNP, and heart rate decreased. Multiple Cox proportional hazards regression analysis was performed using delta% values (post vs pre-training) of LVEF, heart rate, NE, and NT-proBNP alongwith baseline covariates, revealing delta value of NE as the strongest predictor of cardiac mortality. Noteworthy, training reduced NT-proBNP in both survivor and non-survivor patients, while a lack of reduction of NE was observed in non survivors. Conclusions: In ourHF population, short-termchanges ofNE after exercise training independently predicted longterm cardiac mortality. (C) 2013 Elsevier Ireland Ltd. All rights reserved.