Biomarkers and arterial stiffness. A sub-analysis of the “Exercise training in heart failure with reduced ejection fraction and permanent atrial fibrillation: A randomized clinical trial”

Objective Regular exercise improves outcomes in patients with Heart Failure (HF) and Atrial Fibrillation (AF), but its effects on inflammatory pathways and arterial stiffness in HF with Reduced Ejection Fraction (HFrEF) and permanent AF remain uncertain. This study examined the effects of a 12-week aerobic exercise program on biomarkers and arterial stiffness. Design and methods This secondary analysis was derived from a parallel group randomized trial. We recruited 32 patients with HFrEF and permanent AF, randomizing 1:1 to an exercise group (n = 16) or a control group (n = 16). Six participants discontinued the protocol (two dropouts and one death per group), resulting in a final analyzed cohort of 26 patients who completed the study (13-per-group). The exercise group performed supervised aerobic training three times weekly for 12-weeks, while controls received usual care. Levels of BNP, ANP, IL-6, TNF-α, angiotensin II, and arterial stiffness by pulse wave velocity were measured at baseline and post-intervention. Results Baseline characteristics were comparable. After 12-weeks, the exercise group showed significant reductions in BNP, ANP, IL-6, TNF-α, and angiotensin II, whereas the control group exhibited significant increases in ANP, IL-6, TNF-α, and angiotensin II. Arterial stiffness remained unchanged in the exercise group but increased in controls; however, the between-group difference was not statistically significant. Conclusion A 12-week aerobic exercise program favorably modulated inflammatory and neurohormonal biomarkers in patients with HFrEF and permanent AF; however, its effect on arterial stiffness was less clear. Although arterial stiffness progressed in the control group and remained stable in the exercise group, the between-group difference in this change was not statistically significant. As these findings derive from a secondary analysis of a randomized trial, they should be interpreted with caution.