The present study shows that plasma BNP levels reflect left ventricular EDWS more than any other parameter previously reported, not only in patients with SHF, but also in patients with DHF. The relationship of left ventricular EDWS to plasma BNP may provide a better fundamental understanding of the interindividual heterogeneity in BNP levels and their clinical utility in the diagnosis and management of HF.

Intravenous infusion of AM has beneficial hemodynamic and renal effects in patients with CHF.

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Background: It remains unclear whether patients with chronic heart failure (CHF) and advanced left ventricular (LV) dysfunction on β-blocker therapy benefit from exercise training (ET). Methods and Results:We studied 45 CHF patients with advanced LV dysfunction [ejection fraction (LVEF) <25%] and impaired exercise tolerance [normalized peak oxygen uptake (PV · O2) <70%] receiving a β-blocker:33 patients participated in a cardiac rehabilitation program with ET (ET group) and 12 did not (inactive control group). Exercise capacity, LV dimension and plasma B-type natriuretic peptide (BNP) were assessed before and after a 3-month study period. At baseline, both groups had markedly reduced LVEF (ET group 18±4% vs. Control group 18±5%, NS) and impaired exercise capacity (normalized PV · O2 51±10% vs. 55±9%, NS). Although one patient in the ET group withdrew from the program due to worsening CHF, no serious cardiac events occurred during the ET sessions. After 3 months, the ET group (n=24) had significantly improved PV · O2 by 16±15% (1,005±295 to 1,167±397 ml/min, P<0.001), while the PV · O2 of the control group was unchanged. LV end-diastolic dimension decreased in both groups to a similar extent, but plasma BNP was significantly decreased only in the ET group (432 to 214 pg/ml, P<0.05). Conclusions:The data indicate that in CHF patients with advanced LV dysfunction on β-blocker therapy, ET successfully improves exercise capacity and BNP without adversely affecting LV remodeling or causing serious cardiac complications. (Circ J 2011; 75: 1649 - 1655