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Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study.
Circ Heart Fail. 2014 Jan; 7(1):123-30.CH

Abstract

BACKGROUND

Atrial fibrillation (AF) is common among patients with heart failure and preserved ejection fraction (HFpEF), but its clinical profile and impact on exercise capacity remain unclear. RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF) was a multicenter randomized trial testing the impact of sildenafil on peak VO2 in stable outpatients with chronic HFpEF. We sought to compare clinical features and exercise capacity among patients with HFpEF who were in sinus rhythm (SR) or AF.

METHODS AND RESULTS

RELAX enrolled 216 patients with HFpEF, of whom 79 (37%) were in AF, 124 (57%) in SR, and 13 in other rhythms. Participants underwent baseline cardiopulmonary exercise testing, echocardiogram, biomarker assessment, and rhythm status assessment before randomization. Patients with AF were older than those in SR but had similar symptom severity, comorbidities, and renal function. β-blocker use and chronotropic indices were also similar. Despite comparable left ventricular size and mass, AF was associated with worse systolic (lower EF, stroke volume, and cardiac index) and diastolic (shorter deceleration time and larger left atria) function compared with SR. Pulmonary artery systolic pressure was higher in AF. Patients with AF had higher N-terminal pro-B-type natriuretic peptide, aldosterone, endothelin-1, troponin I, and C-telopeptide for type I collagen levels, suggesting more severe neurohumoral activation, myocyte necrosis, and fibrosis. Peak VO2 was lower in AF, even after adjustment for age, sex, and chronotropic response, and VE/VCO2 was higher.

CONCLUSIONS

AF identifies an HFpEF cohort with more advanced disease and significantly reduced exercise capacity. These data suggest that evaluation of the impact of different rate or rhythm control strategies on exercise tolerance in patients with HFpEF and AF is warranted.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00763867.

Authors+Show Affiliations

Division of Cardiology, Mayo Clinic, Rochester, MN.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

24162898

Citation

Zakeri, Rosita, et al. "Impact of Atrial Fibrillation On Exercise Capacity in Heart Failure With Preserved Ejection Fraction: a RELAX Trial Ancillary Study." Circulation. Heart Failure, vol. 7, no. 1, 2014, pp. 123-30.
Zakeri R, Borlaug BA, McNulty SE, et al. Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. Circ Heart Fail. 2014;7(1):123-30.
Zakeri, R., Borlaug, B. A., McNulty, S. E., Mohammed, S. F., Lewis, G. D., Semigran, M. J., Deswal, A., LeWinter, M., Hernandez, A. F., Braunwald, E., & Redfield, M. M. (2014). Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. Circulation. Heart Failure, 7(1), 123-30. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000568
Zakeri R, et al. Impact of Atrial Fibrillation On Exercise Capacity in Heart Failure With Preserved Ejection Fraction: a RELAX Trial Ancillary Study. Circ Heart Fail. 2014;7(1):123-30. PubMed PMID: 24162898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. AU - Zakeri,Rosita, AU - Borlaug,Barry A, AU - McNulty,Steven E, AU - Mohammed,Selma F, AU - Lewis,Gregory D, AU - Semigran,Marc J, AU - Deswal,Anita, AU - LeWinter,Martin, AU - Hernandez,Adrian F, AU - Braunwald,Eugene, AU - Redfield,Margaret M, Y1 - 2013/10/25/ PY - 2013/10/29/entrez PY - 2013/10/29/pubmed PY - 2014/5/28/medline KW - atrial fibrillation KW - exercise KW - heart failure SP - 123 EP - 30 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 7 IS - 1 N2 - BACKGROUND: Atrial fibrillation (AF) is common among patients with heart failure and preserved ejection fraction (HFpEF), but its clinical profile and impact on exercise capacity remain unclear. RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF) was a multicenter randomized trial testing the impact of sildenafil on peak VO2 in stable outpatients with chronic HFpEF. We sought to compare clinical features and exercise capacity among patients with HFpEF who were in sinus rhythm (SR) or AF. METHODS AND RESULTS: RELAX enrolled 216 patients with HFpEF, of whom 79 (37%) were in AF, 124 (57%) in SR, and 13 in other rhythms. Participants underwent baseline cardiopulmonary exercise testing, echocardiogram, biomarker assessment, and rhythm status assessment before randomization. Patients with AF were older than those in SR but had similar symptom severity, comorbidities, and renal function. β-blocker use and chronotropic indices were also similar. Despite comparable left ventricular size and mass, AF was associated with worse systolic (lower EF, stroke volume, and cardiac index) and diastolic (shorter deceleration time and larger left atria) function compared with SR. Pulmonary artery systolic pressure was higher in AF. Patients with AF had higher N-terminal pro-B-type natriuretic peptide, aldosterone, endothelin-1, troponin I, and C-telopeptide for type I collagen levels, suggesting more severe neurohumoral activation, myocyte necrosis, and fibrosis. Peak VO2 was lower in AF, even after adjustment for age, sex, and chronotropic response, and VE/VCO2 was higher. CONCLUSIONS: AF identifies an HFpEF cohort with more advanced disease and significantly reduced exercise capacity. These data suggest that evaluation of the impact of different rate or rhythm control strategies on exercise tolerance in patients with HFpEF and AF is warranted. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00763867. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/24162898/Impact_of_atrial_fibrillation_on_exercise_capacity_in_heart_failure_with_preserved_ejection_fraction:_a_RELAX_trial_ancillary_study_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.113.000568?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -