Influence of Aerobic Exercise Training on Brain Natriuretic Peptide Secretion in Patients in the Chronic Phase of Myocardial Infarction

Abstract

rain natriuretic peptide (BNP) secretion from the left ventricle increases after the occurrence of a myocardial infarction (MI). Its plasma level may reflect the degree of left ventricular dysfunction given the negative correlation between ejection fraction and BNP secretion and also the positive correlation between left ventricular end diastolic pressure and BNP secretion. [1][2][3] The plasma level of BNP, measured during an exercise test, has been shown to increase in patients with MI, 4 but the influence of exercise training on BNP secretion in patients in the chronic phase of MI is still unknown. A great concern of exercise therapy in the chronic phase of MI is its aggravation of left ventricular function. Jugdutt et al reported that patients with left ventricular asynergy of 18% or more had significant topographic abnormalities, with marked regional shape distortion, and showed topographic deterioration with low-level exercise training in the chronic phase of MI. 5 The purpose of the present study was to investigate the influence of aerobic exercise training on left ventricular function, using the plasma level of BNP as a parameter of left ventricular function in patients in the chronic phase of MI. Methods Study SubjectsEighty-four consecutive patients hospitalized for acute MI (AMI) who completed the routine 4-week cardiac rehabilitation program for AMI during hospitalization were assigned alternately to a training group (42 patients) and a nontraining group (42 patients) (non-blind randomized study). Over the course of the study, 7 patients dropped out of the training group and 7 patients refused repeat exercise testing in the nontraining group. Ultimately, the study consisted of 70 patients with a mean age of 62.0±11.3 years (± SD), 40 diagnosed as having anterior MI and 30 as having inferior MI. They were divided into 4 groups, comprising 2 groups that underwent exercise training (group 1, 20 with anterior MI, and group 2, 15 with inferior MI) and two groups that did not undergo exercise training (group 3, 20 with anterior MI, and group 4, 15 with inferior MI). Patients with severe heart failure showing a functional classification of NYHA III or more, angina pectoris, uncontrolled arrhythmia, uncontrolled diabetes mellitus, or who had had coronary artery bypass surgery were excluded. The diagnosis of AMI was made on the basis of chest pain persisting for at least 30 min, an ST-segment elevation of at least 0.1 mV in at least 2 contiguous leads, and elevation of serum creatine kinase-MB (CK-MB) to more than twice the upper limit of the normal range. (1) 20 patients with an anterior MI and exercise training; (2) 20 patients with an anterior MI and no exercise training; (3) 15 patients with an inferior MI and exercise training; and (4) 15 patients with an inferior MI and no exercise training. The training groups performed aerobic exercise 3 times a week for 2 months. Exercise intensity was defined as a heart rate of anaerobic threshold (AT), derived from the treadmill cardiopulmonary exercise testing at ...

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