P3424Absence of BNP decrease after exercise therapy in chronic heart failure patients with chronic atrial fibrillation: comparison with sinus rhythm

Background: Chronic atrial fibrillation (AF) is known to be associated with elevated plasma B-type natriuretic peptide (BNP) levels. Although exercise-based cardiac rehabilitation (ECR) is known to increase exercise capacity (peak oxygen uptake, PVO2) and decrease plasma BNP in patients with chronic heart failure with sinus rhythm (CHF-SR), it remains unknown whether ECR is also effective in increasing PVO2 and decreasing BNP in CHF patients with chronic AF (CHF-AF). Objective: Accordingly, we assessed PVO2 and BNP before and after ECR in CHF-AF and CHF-SR patients. Methods: We screened 365 consecutive hospitalized CHF patients who entered our 3-month ECR program. ECR program consisted of supervised aerobic exercise training (walking and/or cycle ergometer) and patient education. All patients underwent blood sampling and symptom-limited cardiopulmonary exercise testing (CPX, measurements for PVO2) at the beginning and the end of ECR, and received exercise prescription (training HR or Borg scale) after the initial CPX (at 2nd or 3rd week) and continued outpatient ECR for 3 months. Patients with insufficient outpatient ECR session attendance (less than once a week, n=117) or with electrical device implantation (n=59) or paroxysmal AF (n=32) were excluded, and the remaining 157 patients were divided into CHF-AF (n=29) and CHF-SR (n=128) group.