Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction a relax trial ancillary study

Rosita Zakeri, Barry A Borlaug, Steven E. McNulty, Selma F. Mohammed, Gregory D. Lewis, Marc J. Semigran, Anita Deswal, Martin LeWinter, Adrian F. Hernandez, Eugene Braunwald, Margaret May Redfield

Research output: Contribution to journalArticle

74 Citations (Scopus)

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. â-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.

Original languageEnglish (US)
Pages (from-to)123-130
Number of pages8
JournalCirculation: Heart Failure
Volume7
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Atrial Fibrillation
Heart Failure
Exercise
Type 5 Cyclic Nucleotide Phosphodiesterases
Troponin C
Troponin I
Exercise Tolerance
Deceleration
Brain Natriuretic Peptide
Endothelin-1
Random Allocation
Collagen Type I
Heart Atria
Aldosterone
Stroke Volume
Muscle Cells
Pulmonary Artery
Multicenter Studies
Comorbidity
Fibrosis

Keywords

  • Atrial fibrillation
  • Exercise
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction a relax trial ancillary study. / Zakeri, Rosita; Borlaug, Barry A; McNulty, Steven E.; Mohammed, Selma F.; Lewis, Gregory D.; Semigran, Marc J.; Deswal, Anita; LeWinter, Martin; Hernandez, Adrian F.; Braunwald, Eugene; Redfield, Margaret May.

In: Circulation: Heart Failure, Vol. 7, No. 1, 2014, p. 123-130.

Research output: Contribution to journalArticle

Zakeri, Rosita ; Borlaug, Barry A ; McNulty, Steven E. ; Mohammed, Selma F. ; Lewis, Gregory D. ; Semigran, Marc J. ; Deswal, Anita ; LeWinter, Martin ; Hernandez, Adrian F. ; Braunwald, Eugene ; Redfield, Margaret May. / Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction a relax trial ancillary study. In: Circulation: Heart Failure. 2014 ; Vol. 7, No. 1. pp. 123-130.
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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. {\^a}-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.",
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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 May

PY - 2014

Y1 - 2014

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. â-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.

AB - 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. â-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.

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KW - Exercise

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