남·녀 심부전증 환자의 12주간 운동후Brain Natriuretic Peptide와 심장기능의 상관분석 = Correlates of BNP and cardiac function after 12-weeks exercise training in patient with chronic heart failure

다국어 초록 (Multilingual Abstract)

The purpose of this study was to analyze the correlation between cardiac function and BNP of patients with chronic heart failure. Eighteen patients participated in this study consisting of men group(N=9) and women group(N=9). Exercise program was consisted of aerobic exercise and strength exercise for 12 weeks. We were measured left ventricular ejection fraction(EF), left ventricular cavity volume(LVESV, LVEDV), mitral flow velocity(E, A, E/A, DT) and brain natriuretic peptide(BNP) before and after 12 weeks of exercise training. Paired t test was performed for each parameter. For compared with between groups, ANCOVA was performed and Pearson correlation was used to correlate BNP and others. BNP was decreased significantly after 12 weeks in women group(p<.05). There were no significant differences between the two groups. But BNP was positively associated with LVEDV(r=.705, p<.05) in men group, and positively associated with LVESV(r=.811, p<.01), LVEDV(r=.897, p<.01) in women group. We concluded that improvements in systolic and diastolic function may reduce BNP after exercise training, and BNP was correlated with LVESV and LVEDV.

국문 초록 (Abstract)

본 연구의 목적은 운동을 통해 좌심실의 이완기능과 수축기능이 향상되면 그로 인해 BNP의 분비도 적어지게 되고 이러한 관계는 높은 상관을 가질 것이라는 가정하에 12주간의 운동후 성별에 따른 BNP와 심장기능간의 상관을 분석하여 트레이닝이 심부전증 환자의 심장기능에 어떻게 영향을 주며 심장기능의 변화와 BNP의 변화가 어떠한 상관관계가 있는지 알아보는 것이다. 총 18명의 환자가 참가하여 남·녀 각각 9명씩 그룹을 형성하였다. 운동프로그램은 12주간 유산소운동과 근력운동으로 구성하였고, 주당 3회의 빈도로 실시하였다. 좌심실 구출률(EF), 좌심실의 수축기와 이완기 용적(LVESV, LVEDV), 승모판 혈류 속도(E, A, E/A, DT), 그리고 BNP를 운동 전후에 측정하였다. 집단내의 운동전후 비교는 종속 t 검정을 실시하였고, 집단간 비교는 사전값을 공변인으로 하는 공변량분석을 실시하였다. 심장기능과 BNP와의 상관관계는 단순상관분석을 실시하였다. 본 연구에서 여성집단에서 12주후 BNP가 유의하게 감소하였으며(p<.05), 집단간 차이는 없었다. 상관분석에서는 남성집단에서 좌심실이완기말 용적과 정적인 상관을 보였으며(r=.705, p<.05), 여성집단에서는 수축기말 용적(r=.811, p<.01)과 이완기말 용적(r=.897, p<.01)에서 유의한 상관을 보였다. 결론적으로 트레이닝 후에 심장의 수축 및 이완기능이 BNP를 감소시켰고, 수축기말 및 이완기말 용적이 BNP와 상관관계가 높은 것으로 나타났다.

참고문헌 (Reference)

1 김연재, "허혈성 심질환에서 운동에 따른 Brain Natriuretic Peptide 농도의 변화" 31 (31): 625-636, 2001

2 여남회, "장기간 환기역치 운동이 환자치료에 미치는 효과에 관한 연구.대한스포츠의학회지" 18 (18): 147-156, 2000

3 진은선, "울혈성 심부전과 허혈성 심질환에서 BNP의 유용성" 경희대학교 대학원 2004

4 이성수, "운동강도가 복부비만 중년여성의 심장기능 및 NT-pro BNP농도에 미치는 영향" 동아대학교 대학원 2006

5 Pfeffer, M. A., "Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications" 81 : 1161-1172, 1990

6 Cowie, M. R., "Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care" 350 (350): 1349-1353, 1997

7 Hurrell, D. G., "Utility of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: A simultaneous catheterization and Doppler echocardiographic study" 30 (30): 459-467, 1997

8 유병수, "Usefulness of BNP test as cardiovascular biomarker" 7 (7): 26-31, 2005

9 Tavazzi, L., "Short-term hemodynamic evolution and late follow-up of post-infarction patients with left ventricular dysfunction undergoing a physical training programme" 12 : 657-665, 1991

10 Arakawa, N., "Relationship between plasma level of brain natriuretic peptide and myocardial infarct size" 85 : 334-340, 1994

11 Nishikimi, T., "Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension" 28 : 22-30, 1996

12 Gaudron, P., "Progressive left ventricular dysfunction and remodeling after acute myocardial infarction. Potential mechanisms and early predictors" 87 : 755-63, 1993

13 Nagaya, N., "Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction" 135 : 21-28, 1998

14 Stein, B. C., "Natriuretic peptides:physiology, therapeutic potential, and risk stratification in ischemic heart disease" 135 : 914-923, 1998

15 Bentzen, H., "Influence of training habits on exercise-induced changes in plasma atrial and brain natriuretic peptide and urinary excretion of aquaporin-2 in healthy man" 62 (62): 541-551, 2002

16 Butterfield, J. A., "Exercise training in patients with stable chronic heart failure: effects on thoracic impedance cardiography and B-type natriuretic peptide" 28 (28): 33-37, 2008

17 Sullivan, M. J., "Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects" 78 : 506-515, 1988

18 Matsumoto, A., "Effects of exercise on plasma level of brain natriuretic peptide in congestive heart failure with and without left ventricular dysfunction.American Heart Journal" 129 : 139-145, 1995

19 Hedback, B., "Can high-risk patients after myocardial infarction participate in comprehensive cardiac rehabilitation?" 22 : 15-20, 1990

20 Maisel, A., "B-type natriuretic peptide levels: a potential novel "white count" for congestive heart failure" 347 : 161-167, 2001

21 Kohno, M., "Atrial and brain natriuretic peptides: Secretion during exercise in patients with essential hypertension and modulation by acute angiotensin-converting enzyme inhibition" 19 : 193-200, 1992

22 Sudoh, T., "A new natriuretic peptide in human brain" 332 : 78-81, 1988

23 Haykowsky, M. J., "A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients" 49 (49): 2329-2336, 2007

24 이한준, "12주간 운동이 심부전증 환자 심장의 수축기능과 이완기능에 미치는 영향" 한국운동생리학회 15 (15): 69-76, 2006