Dataset Information

Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure?

ABSTRACT:

Background

Cardiorespiratory fitness (CRF) is closely linked to health status and clinical outcomes in heart failure (HF) patients. We aimed to test whether biomarkers can reflect CRF and its change over time.

Methods

This post hoc analysis used data from ambulatory cohorts of heart failure with reduced ejection fraction (HFrEF) (IRONOUT) and heart failure with preserved ejection fraction (HFpEF) (RELAX). Cardiopulmonary exercise testing, 6-minute walk distance (6MWD), and serum biomarkers were measured at baseline and 16- or 24-week follow-up (for IRONOUT and RELAX respectively). Biomarkers included N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble ST2, growth differentiation factor-15, and Galectin-3.

Results

Analysis included 225 patients with HFrEF and 216 with HFpEF. Baseline peak VO₂, VE/VCO₂ slope, and 6MWD showed a mild correlation with the doubling of all 4 tested biomarkers in HFrEF and HFpEF. Following multivariable adjustment (including all biomarkers), the only significant association between change in biomarker and functional parameter in HFrEF was change in NT-proBNP and change in VE/VCO₂ slope (3.596% increase per doubling, 95% CI 0.779-6.492, P?=?.012). In HFpEF, a decrease in peak VO₂ was associated with an increase in NT-proBNP (-0.726?mL/min/kg per doubling, 95% CI -1.100 to -0.353, P?ConclusionsIn these ambulatory trial cohorts, NT-proBNP was associated with baseline and change in CRF in HFrEF and HFpEF. In contrast, novel biomarkers do not appear suitable as a reliable surrogate for serial assessment of exercise capacity in HF patients given lack of consistent independent association with CRF beyond traditional risk factors and NT-proBNP.

SUBMITTER: Fudim M

PROVIDER: S-EPMC7008085 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure?

Fudim Marat M Kelly Jacob P JP Jones Aaron D AD AbouEzzeddine Omar F OF Ambrosy Andrew P AP Greene Stephen J SJ Reddy Yogesh N V YNV Anstrom Kevin J KJ Alhanti Brooke B Lewis Gregory D GD Hernandez Adrian F AF Felker G Michael GM

American heart journal 20191116

<h4>Background</h4>Cardiorespiratory fitness (CRF) is closely linked to health status and clinical outcomes in heart failure (HF) patients. We aimed to test whether biomarkers can reflect CRF and its change over time.<h4>Methods</h4>This post hoc analysis used data from ambulatory cohorts of heart failure with reduced ejection fraction (HFrEF) (IRONOUT) and heart failure with preserved ejection fraction (HFpEF) (RELAX). Cardiopulmonary exercise testing, 6-minute walk distance (6MWD), and serum b ...[more]

PMID: 31805424

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Project description:BackgroundExercise training is recommended for chronic heart failure (HF) patients to improve functional status and reduce risk of adverse outcomes. Elevated plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cardiac troponin T (cTnT) are associated with increased risk of adverse outcomes in this patient population. Whether exercise training leads to improvements in biomarkers and how such improvements relate to clinical outcomes are unclear.Methods and resultsAmino-terminal pro-brain natriuretic peptide, hs-CRP, and cTnT levels were assessed at baseline and 3 months in a cohort of 928 subjects from the HF-ACTION study, a randomized clinical trial of exercise training versus usual care in chronic HF patients with reduced left ventricular ejection fraction (<35%). Linear and logistic regressions were used to assess 3-month biomarker levels as a function of baseline value, treatment assignment (exercise training vs usual care), and volume of exercise. Linear regression and Cox proportional hazard modeling were used to evaluate the relations between changes in biomarker levels and clinical outcomes of interest that included change in peak oxygen consumption (peak VO2), hospitalizations, and mortality. Exercise training was not associated with significant changes in levels of NT-proBNP (P = .10), hs-CRP (P = .80), or detectable cTnT levels (P = .83) at 3 months. Controlling for baseline biomarker levels or volume of exercise did not alter these findings. Decreases in plasma concentrations of NT-proBNP, but not hs-CRP or cTnT, were associated with increases in peak VO2 (P < .001) at 3 months and decreased risk of hospitalizations or mortality (P ≤ .04), even after adjustment for a comprehensive set of known predictors.ConclusionsExercise training did not lead to meaningful changes in biomarkers of myocardial stress, inflammation, or necrosis in patients with chronic HF. Only improvements in NT-proBNP translated to reductions in peak VO2 and reduced risk of clinical events.

Dataset Information

Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure?

Background

Methods

Results

Publications

Are existing and emerging biomarkers associated with cardiorespiratory fitness in patients with chronic heart failure?

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