Effects of a cardiac rehabilitation programme on plasma cardiac biomarkers in patients with chronic heart failure

Cardiac rehabilitation (CR) improves the symptoms, exercise capacity and quality of life of chronic heart failure (CHF) patients. Its effects on new plasma biomarkers of prognostic importance are unknown. The present study aimed at analysing the effects of a structured CR programme on plasma cardiac biomarkers in a large population of patients with CHF and reduced left ventricular ejection fraction (LVEF). We enrolled 107 consecutive CHF patients with LVEF ≤ 45% in an ambulatory CR programme. Peak VO2 and plasma levels of Galectin-3, mid-regional proANP (MR-proADM), soluble suppressor of tumorigenicity 2 (sST2) and mid-regional pro-adrenomedullin (MR-proANP) were assessed at inclusion and at the end of CR. Twenty-four unenrolled patients were managed with standard medical care and evaluated over the same period (no-CR group). Galectin-3, sST2, MR-proADM and MR-proANP plasma levels decreased after CR, with respective median reductions of 6.3% for Galectin 3 (p < 0.001), 7.4% for sST2 (p = 0.036), 6.4% for MR-proADM (p = 0.001) and 16% for MR-proANP (p < 0.001). MR-proADM was negatively correlated with peak VO2 (ρ = −0.529, 95% confidence interval [CI] −0.654 to −0.375, p < 0.001), and so were their relative variations along the course of CR (ρ = −0.357, 95% CI –0.518 to −0.172, p < 0.001). No change occurred in terms of biomarkers in the no-CR group. Plasma cardiac biomarkers such as Galectin-3, MR-proADM, sST2 and MR-proANP all decreased after CR in CHF patients, suggesting an overall improvement in the neuro-hormonal profile.