Korean Circ J.  2010 Apr;40(4):172-178. 10.4070/kcj.2010.40.4.172.

The Relationship Between Heart Rate Recovery and Brain Natruretic Peptide in Patients With Chest Discomfort

• Lee JE
• Kim BS
• Park W
• Huh JK
• Kim BJ
• Sung KC
• Kang JH
• Lee MH
• Park JR

• KMID: 2145553
• DOI: http://doi.org/10.4070/kcj.2010.40.4.172

Abstract

BACKGROUND AND OBJECTIVES
The correlation between brain natruretic peptide (BNP) level and cardiac autonomic function has been studied in type 2 diabetic patients. However, there is limited data from patients with normal systolic function. We evaluated the association between heart rate recovery (HRR) representing autonomic dysfunction and three plasma BNP levels: pre-exercise, post-exercise, and change during exercise in patients with normal systolic function. SUBJECTS AND METHODS: Subjects included 105 patients with chest pain and normal systolic function. HRR was defined as the difference between the peak heart rate and the rate measured two minutes after completion of a treadmill exercise test. We measured plasma BNP levels before exercise, 5 minutes after completion of exercise, and during exercise (absolute value of difference between pre- and post-exercise BNP levels). RESULTS: Patients with abnormal HRR values (< or =24 beats for the first 2 minutes of HRR) had lower high-density lipoprotein, lower peak heart rates, and higher pre- and post-exercise BNP levels than patients with normal HRR values. The patients with coronary artery disease (CAD) had abnormal HRR. However, no significant differences were found between the two groups in terms of history of hypertension (HTN), diabetes, and peak systolic blood pressure (SBP) and diastolic blood pressure (DBP). HRR was significantly associated with pre-exercise BNP (r=-0.36, p=0.004) and post-exercise BNP (r=-0.27, p=0.006), but not BNP changes. Further, pre-exercise BNP levels showed a greater association with HRR than post-exercise BNP levels. CONCLUSION: HRR is independently associated with pre-exercise and post-exercise BNP levels, even in patients with normal systolic function.

Keyword

Heart rate; Natruretic Peptide, Brain; Ventricular ejection fraction; Autonomic dysfunction

MeSH Terms

Blood Pressure
Brain
Chest Pain
Coronary Artery Disease
Exercise Test
Heart
Heart Rate
Humans
Hypertension
Lipoproteins
Plasma
Stroke Volume
Thorax
Lipoproteins

Reference

1. Arai Y, Saul JP, Albrecht P, et al. Modulation of cardiac autonomic activity during and immediately after exercise. Am J Physiol. 1989. 256:H132–H141.

2. Imai K, Sato H, Hori M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994. 24:1529–1535.

3. Pierpont GL, Stolpman DR, Gornick CC. Heart rate recovery post-exercise as an index of parasympathetic activity. J Auton Nerv Syst. 2000. 80:169–174.

4. Carnethon MR, Jacobs DR Jr, Sidney S, Liu K. Influence of autonomic nervous system dysfunction on the development of type 2 diabetes: the CARDIA study. Diabetes Care. 2003. 26:3035–3041.

5. Yu CM, Sanderson JE, Chan S, Yeung L, Hung YT, Woo KS. Right ventricular diastolic dysfunction in heart failure. Circulation. 1996. 93:1509–1514.

6. Lind L, Andrén B. Heart rate recovery after exercise is related to the insulin resistance syndrome and heart rate variability in elderly men. Am Heart J. 2002. 144:666–672.

7. Shishehbor MH, Hoogwerf BJ, Lauer MS. Association of triglyceride-to-HDL cholesterol ratio with heart rate recovery. Diabetes Care. 2004. 27:936–941.

8. Spies C, Otte C, Kanaya A, Pipkin SS, Schiller NB, Whooley MA. Association of metabolic syndrome with exercise capacity and heart rate recovery in patients with coronary heart disease in the heart and soul study. Am J Cardiol. 2005. 95:1175–1179.

9. Kim HS, Lee JH, Kwon YS, et al. Changes in heart rate during and after exercise treadmill test as prognostic factor in cardiovascular disease. Korean Circ J. 2004. 34:170–177.

10. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med. 2000. 132:552–555.

11. Diaz LA, Brunken RC, Blackstone EH, Snader CE, Lauer MS. Independent contribution of myocardial perfusion defects to exercise capacity and heart rate recovery for prediction of all-cause mortality in patients with known or suspected coronary heart disease. J Am Coll Cardiol. 2001. 37:1558–1564.

12. Cowie MR, Mendez GF. BNP and congestive heart failure. Prog Cardiovasc Dis. 2002. 44:293–321.

13. Mukoyama M, Nakao K, Hosoda K, et al. Brain natriuretic peptide as a novel cardiac hormone in humans: evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest. 1991. 87:1402–1412.

14. Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001. 104:1694–1740.

15. Choe HM, Yoo BS, Ryu HY, et al. The early changing pattern of the B-type natriuretic peptide concentration and its significance as a prognostic marker after acute myocardial infarction. Korean Circ J. 2006. 36:526–534.

16. Nakamura M, Endo H, Nasu M, Arakawa N, Segawa T, Hiramori K. Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population. Heart. 2002. 87:131–135.

17. Yufu K, Takahashi N, Nakagawa M, Hara M, Saikawa T, Yoshimatsu H. Brain natriuretic peptide and cardiac autonomic function in type 2 diabetic patients. Diabetes Res Clin Pract. 2006. 72:12–19.

18. Foote RS, Pearlman JD, Siegel AH, Yeo KT. Detection of exercise-induced ischemia by changes in B-type natriuretic peptides. J Am Coll Cardiol. 2004. 44:1980–1987.

19. Savin WM, Davidson DM, Haskell WL. Autonomic contribution to heart rate recovery from exercise in humans. J Appl Physiol. 1982. 53:1572–1575.

20. Choi SH, Lee KJ, Lee KH, et al. The value of the first two minutes of heart rate recovery after exercise treadmill test in predicting the presence and severity of coronary artery disease. Korean Circ J. 2007. 37:432–436.

21. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003. 348:2007–2018.

22. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003. 289:194–202.

23. Owan TE, Redfield MM. Epidemiology of diastolic heart failure. Prog Cardiovasc Dis. 2005. 47:320–332.

24. Baicu CF, Zile MR, Aurigemma GP, Gaasch WH. Left ventricular systolic performance, function, and contractility in patients with diastolic heart failure. Circulation. 2005. 111:2306–2312.

25. Morita E, Yasue H, Yoshimura M, et al. Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation. 1993. 88:82–91.

26. Wolk R, Somers VK, Gibbons RJ, Olson T, O'Malley K, Johnson BD. Pathophysiological characteristics of heart rate recovery in heart failure. Med Sci Sports Exerc. 2006. 38:1367–1373.

27. Desai MY, De la Pena-Almaguer E, Mannting F. Abnormal heart rate recovery after exercise as a reflection of an abnormal chronotropic response. Am J Cardiol. 2001. 87:1164–1169.

28. Win HK, Chang SM, Raizner M, et al. Percent change in B-type natriuretic peptide levels during treadmill exercise as a screening test for exercise-induced myocardial ischemia. Am Heart J. 2005. 150:695–700.

29. Wennerblom B, Lurje L, Solem J, et al. Reduced heart rate variability in ischemic heart disease is only partially caused by ischemia: an HRV study before and after PTCA. Cardiology. 2000. 94:146–151.

30. Sidney S, Sternfeld B, Gidding SS, et al. Cigarette smoking and submaximal exercise test duration in a biracial population of young adults: the CARDIA study. Med Sci Sports Exerc. 1993. 25:911–916.