The effects of early exercise on cardiovascular biomarkers in patients with congestive heart failure.

Abstract

Background: Exercise training improves functional outcomes in chronic heart failure (HF), but the effects of early in-hospital physical activity on cardiovascular biomarkers and prognosis in acute congestive heart failure (AHF) patients remain unclear. This study investigated the short-term impact of early rehabilitation on prognostic biomarkers-high-sensitivity troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble suppression of tumourigenesis-2 (sST2), galectin-3 (Gal-3) and endothelin-1 (ET-1)-and evaluated associations with clinical outcomes.

Methods and results: A total of 118 hospitalized AHF patients (35 controls and 83 exercise group) underwent biomarker measurement before and after supervised rehabilitation using non-invasive cardiac output monitoring. Serum levels of NT-proBNP, hs-TnT, sST2, Gal-3, and ET-1 were analysed. Prognosis was assessed via 12-month follow-up for all-cause mortality. Statistical analysis included ANOVA for biomarker changes and Kaplan-Meier survival analysis. Post-intervention, NT-proBNP levels increased significantly in the exercise group (2900 ± 700 pg/mL to 3500 ± 760 pg/mL, P = 0.012), as did ET-1 (1.9 ± 0.4 pg/mL to 2.4 ± 0.5 pg/mL, P = 0.018). Hs-TnT, sST2 and Gal-3 showed no significant changes (all P > 0.05). Survival analysis demonstrated higher baseline hs-TnT [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.3-3.4] and greater NT-proBNP elevation post-exercise (ΔNT-proBNP HR 1.8, 95% CI 1.1-2.9) were independent predictors of mortality.

Conclusions: Early in-hospital exercise in AHF patients transiently elevates NT-proBNP and ET-1, indicative of acute haemodynamic stress, without altering myocardial injury or fibrosis markers (hs-TnT, sST2 and Gal-3). Elevated baseline hs-TnT and post-exercise NT-proBNP increases correlate with poorer survival, highlighting their prognostic value in risk assessment.