N-terminal pro-atrial natriuretic peptide and exercise prescription in patients with myocardial infarction

Regul Pept. 2007 Jun 7;141(1-3):154-8. doi: 10.1016/j.regpep.2006.12.024. Epub 2007 Jan 12.


Background: Left ventricular end-diastolic pressure (LVEDP) during exercise workload is an important parameter to guide an exercise prescription for patients with cardiovascular disease. Plasma levels of neuro-hormonal factors can be used as a reflection of real-time LVEDP, but its utility is limited by its short half-life. By contrast, the N-terminal fragment of pro-ANP (NT-ANP) has a longer half-life of 1 h.

Objective: To determine whether plasma NT-ANP levels at 30 min after exercise can be used as a marker of LVEDP during peak exercise workload in patients with previous myocardial infarction.

Patients: Twenty patients with a previous history of myocardial infarction.

Interventions: Cardiopulmonary exercise test was performed to determine peak VO(2) and anaerobic threshold. Plasma levels of ANP, BNP, NT-ANP, vasopressin and plasma catecholamine were measured at rest, maximum exercise, and 30 min after exercise (recovery).

Results: With the exception of NT-ANP, the levels of each of neuro-hormonal factors peaked at maximum exercise and returned to baseline at recovery. By contrast, NT-ANP levels also increased at peak exercise but remained elevated at 30 min after exercise. Furthermore, NT-ANP levels at recovery correlated with ANP levels at maximum exercise (p<0.01, R=0.75), left ventricular ejection fraction (p<0.02, R=-0.54) and left ventricular systolic dimension (p<0.015, R=0.50).

Conclusion: Plasma NT-ANP levels at 30 min after exercise reflect ANP levels at maximum exercise and left ventricular overload during exercise. These data indicate that plasma NT-ANP after exercise may be a useful parameter to guide prescription of cardiac rehabilitation.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Atrial Natriuretic Factor / blood*
  • Blood Pressure
  • Catecholamines / blood
  • Exercise*
  • Female
  • Half-Life
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Natriuretic Peptide, Brain / blood
  • Oxygen Consumption
  • Peptide Fragments / blood*
  • Protein Precursors / blood*
  • Time Factors
  • Vasopressins / blood
  • Ventricular Dysfunction, Left / rehabilitation*


  • Catecholamines
  • Peptide Fragments
  • Protein Precursors
  • Vasopressins
  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor