Key result
During exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy, BNP levels significantly increased at peak exercise in those with preserved left ventricular contractile reserve (median 59 to 91 ng/L, p<0.001).
Why the study?
Does exercise stress echocardiography induce different BNP responses in patients with idiopathic dilated cardiomyopathy with or without preserved left ventricular contractile reserve?
Observational (n=55)
No
Does exercise stress echocardiography induce different BNP responses in patients with idiopathic dilated cardiomyopathy with or without preserved left ventricular contractile reserve?
Absolute Event Rate: 91% vs 59%
p-value: p=<0.001
An increase in BNP during physical exercise in patients with idiopathic dilated cardiomyopathy suggests a preserved contractile reserve of the left ventricle.
BNP rise during exercise may indicate preserved contractile reserve in idiopathic dilated cardiomyopathy; hypothesis-generating and requires prospective validation before clinical use.
Introduction: The study of importance of left ventricular contractile reserve presence and changes plasma brain natriuretic peptide levels (BNP) during exercise in patinets with idiopathic dilated cardiomyopathy is very popular today, but these two parametres have rarely been interconnected. The study of response BNP during echocardiography stress tests in patients with idiopathic dilated cardiomyopathy with or without preserved left ventricular contractile reserve. We studied 55 consecutive patients with idiopathic dilated cardiomyopathy (mean age 54.98 ± 9.84, 49 (89.1%) male) treated in the outpatient clinic for heart failure at the Institute of Cardiovascular Diseases "Dedinje". All the patients underwent the echocardiography stress test. Contractile reserve was assessed by measuring of the changes of the left ventricle ejection fraction basally and in the first minute after the strongest stress. Level of BPN was measured at rest, in the first minute and after 20 minutes of maximal exercise stress. Following the kinetics of BNP level during stress testing, we find that in patients with preserved left ventricular contractile reserve BNP level is rising at maximum load achieved (Mediana (IQR) - 59 (22-113) vs. 91 (37-135) vs. 78 (30-159) ng/L, p<0.001), whereas in patients without preserved left ventricular contractile reserve BNP level does not change significantly (Mediana (IQR) – 89 (50-322) vs. 119.5 (61.3-321.8) vs. 136 (72- 281), p=0.102). The increase in BNP in the peak load compared to its value at rest was positively correlated with preserved contractile reserve (r=0.38, p=0.009), better WMSI at rest (r=-0.28, p=0.04), greater difference in the double product (r=0.40, p=0.002), as well as the work accomplished on the test (r = 0.47, p <0.001), and longer duration of the test (r = 0.43, p = 0.001). The increase in BNP during physical exercise in patients with idiopathic dilated cardiomyopathy suggests a preserved contractile reserve of the left ventricle.
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Perić et al. (2015) conducted an observational in Idiopathic dilated cardiomyopathy (n=55). Exercise stress echocardiography vs. Baseline (rest) was evaluated on Change in BNP levels from rest to maximum load in patients with preserved left ventricular contractile reserve (p=<0.001). During exercise stress echocardiography in patients with idiopathic dilated cardiomyopathy, BNP levels significantly increased at peak exercise in those with preserved left ventricular contractile reserve (median 59 to 91 ng/L, p<0.001).
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