N-terminal pro–brain natriuretic peptide and exercise capacity in chronic heart failure: Data from the Heart Failure and a Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) study
Section snippets
Methods
Details of design, rationale, and primary results of HF-ACTION have been published elsewhere.12, 13 Briefly, HF-ACTION (clinicaltrials.gov, NCT00047437) was a randomized clinical trial evaluating the effect of exercise training on long term morbidity and mortality in patients with chronic heart failure due to left ventricular systolic dysfunction. Enrolled patients were randomized to exercise training in addition to usual care versus usual care alone. HF-ACTION was approved by local
Study cohort
Baseline characteristics for the study cohort are shown in Table I. Generally, the cohort in whom NT-proBNP data were available (n = 1383) was similar to the overall study population (n = 2331). The study cohort was diverse with regard to gender (29% women), race (34% African-American), and age (20% with age ≥70). The mean ejection fraction was 25% and most patients (66%) had New York Heart Association (NYHA) class II heart failure symptoms. Notably, patients enrolled in HF-ACTION were
Discussion
The primary finding of this analysis was that NT-proBNP levels were associated with both peak Vo2 and distance in the 6-minute walk test in a large well-treated contemporary cohort of patients with chronic heart failure. NT-proBNP was the most significant overall predictor of peak Vo2 even after adjustment for 35 demographic and clinical candidate variables. For distance in the 6-minute walk test, NT-proBNP was also a significant independent predictor of exercise capacity, although the
Conclusions
NT-proBNP was strongly associated with peak Vo2 in a large well-treated cohort of patients with heart failure due to left ventricular systolic dysfunction. NT-proBNP was the strongest predictor of peak Vo2, even after adjustment for multiple other demographic and clinical characteristics. NT-proBNP was also significantly associated with distance in the 6-minute walk test, although this relationship was substantially weaker than for peak Vo2. These data support the concept that hemodynamic
Disclosures
M. Felker, C. O'Connor, and K. Adams have received research funding and served as consultants to Roche Diagnostics. D. Whellan, W. Kraus, R. Clare, F. Zannad, M. Donahue, R. McKelvie, and I. Piña have no conflicts of interest to disclose.
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Cited by (0)
ClinicalTrials.gov identifier: NCT00047437.
A complete list of the HF-ACTION investigators is available as an appendix in the introduction of this supplement. This research was supported by National Institutes of Health grants: 5U01HL063747, 5U01HL068973, 5U01HL066501, 5U01HL066482, 5U01HL064250, 5U01HL066494, 5U01HL064257, 5U01HL066497, 5U01HL068980, 5U01HL064265, 5U01HL066491, 5U01HL064264, 5U01HL066461, R37AG18915, P60AG10484.