Impact of Exercise Training on CRP & BNP in Patients with Heart Failure with Reduced EF (HFrEF)

Abstract Background: Brain Naturetic Peptide (BNP) and C-Reactive Protein (CRP) were found to be independently correlated to mortality and morbidity in heart failure patients. While exercise has tremendous beneficial hemodynamic and cardiovascular impact, there is, yet, a scarcity in literature data to elaborate on the impact of ET on cardiac biomarkers. Recent metanalysis of relatively small randomized trials reveal that exercise training (ET) can lower their levels significantly. Aim of Study: This study sought to identify the impact of low-intensity exercise training on serum levels of CRP, BNP and cardiac function indices as secondary endpoints in patients with HFrEF. Patients and Methods: Forty HFrEF patients were referred for a 3 month low-intensity exercise protocol (1-2.5 mph or 1.6-4 km/hr, 0% grade) guided by Borg scale (11-13 ) at Ain Shams cardiac rehabilitation program in the period between October, 2013 and January, 2015. Exercise training was monitored by patients' tolerance, ECG and BP response. A full echocardiography and blood levels of BNP and CRP were obtained before and after completing the program. Results: Exercise training significantly reduced BNP levels but had non- significant impact on CRP (238.00±123.687 vs. 161.68±79.567pg/ml, p-value <0.001) and (5.61±1.98 vs. 4.86±2.37mg/ml, p-value=0.128) respectively. LVEF signif-icantly improved and LV reverse remodeling was observed in 8 patients (20% of patients) by the end of the exercise training program. Right ventricular PW tissue Doppler-derived peak systolic (RV-s') and Tricuspid Annular Plane Systolic Excursion TAPSE showed significant improvement (11.93±  2.505 vs 12.15±2.558cm/s, p-value <0.001) and (19.40±3.973 vs. 19.80±4.071, p=0.005) respectively. Conclusion: In patients with HFrEF, low-intensity exercise training program significantly improved BNP levels, but had a non-significant effect on CRP levels. The echocardiographic determinants of systolic and diastolic functions significantly improved.