Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients

Piergiuseppe Agostoni, Michele Emdin, Ugo Corrà, Fabrizio Veglia, Damiano Magrì, Calogero C. Tedesco, Emanuela Berton, Claudio Passino, Erika Bertella, Federica Re, Alessandro Mezzani, Romualdo Belardinelli, Chiara Colombo, Rocco La Gioia, Marco Vicenzi, Alberto Giannoni, Domenico Scrutinio, Pantaleo Giannuzzi, Claudio Tondo, Andrea Di Lenarda & 3 others Gianfranco Sinagra, Massimo F. Piepoli, Marco Guazzi

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Aims: The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown. Methods and results: We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation (n = 180) and sinus rhythm (n = 762). By multivariable logistic regression analysis, peak VO2 (OR 0.376, 95% CI 0.240-0.588, P <0.0001), O2pulse (VO 2/heart rate, HR) (OR 0.236, 95% CI 0.152-0.366, P <0.0001), VCO2 (OR 3.97, 95% CI 2.163-7.287, P <0.0001), and ventilation (OR 1.38, 95% CI 1.045-1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73%) atrial fibrillation and in 649 of 762 (85%) sinus rhythm patients (P = 0.0002). By multivariable logistic regression analysis, only peak VO2 (OR 0.214, 95% CI 0.155-0.296, P <0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR (P <0.0001) and higher VO2 (P <0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation. Conclusion: In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO2. The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO 2 is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.

Original languageEnglish
Pages (from-to)2367-2372
Number of pages6
JournalEuropean Heart Journal
Volume29
Issue number19
DOIs
Publication statusPublished - Oct 2008

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Anaerobic Threshold
Atrial Fibrillation
Heart Failure
Exercise
Heart Rate
Logistic Models
Regression Analysis
Exercise Tolerance
Exercise Test
Uncertainty
Ventilation
Observation

Keywords

  • Anaerobic threshold
  • Atrial fibrillation
  • Cardiopulmonary exercise testing
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients. / Agostoni, Piergiuseppe; Emdin, Michele; Corrà, Ugo; Veglia, Fabrizio; Magrì, Damiano; Tedesco, Calogero C.; Berton, Emanuela; Passino, Claudio; Bertella, Erika; Re, Federica; Mezzani, Alessandro; Belardinelli, Romualdo; Colombo, Chiara; La Gioia, Rocco; Vicenzi, Marco; Giannoni, Alberto; Scrutinio, Domenico; Giannuzzi, Pantaleo; Tondo, Claudio; Di Lenarda, Andrea; Sinagra, Gianfranco; Piepoli, Massimo F.; Guazzi, Marco.

In: European Heart Journal, Vol. 29, No. 19, 10.2008, p. 2367-2372.

Research output: Contribution to journalArticle

Agostoni, P, Emdin, M, Corrà, U, Veglia, F, Magrì, D, Tedesco, CC, Berton, E, Passino, C, Bertella, E, Re, F, Mezzani, A, Belardinelli, R, Colombo, C, La Gioia, R, Vicenzi, M, Giannoni, A, Scrutinio, D, Giannuzzi, P, Tondo, C, Di Lenarda, A, Sinagra, G, Piepoli, MF & Guazzi, M 2008, 'Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients', European Heart Journal, vol. 29, no. 19, pp. 2367-2372. https://doi.org/10.1093/eurheartj/ehn361
Agostoni, Piergiuseppe ; Emdin, Michele ; Corrà, Ugo ; Veglia, Fabrizio ; Magrì, Damiano ; Tedesco, Calogero C. ; Berton, Emanuela ; Passino, Claudio ; Bertella, Erika ; Re, Federica ; Mezzani, Alessandro ; Belardinelli, Romualdo ; Colombo, Chiara ; La Gioia, Rocco ; Vicenzi, Marco ; Giannoni, Alberto ; Scrutinio, Domenico ; Giannuzzi, Pantaleo ; Tondo, Claudio ; Di Lenarda, Andrea ; Sinagra, Gianfranco ; Piepoli, Massimo F. ; Guazzi, Marco. / Permanent atrial fibrillation affects exercise capacity in chronic heart failure patients. In: European Heart Journal. 2008 ; Vol. 29, No. 19. pp. 2367-2372.
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abstract = "Aims: The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown. Methods and results: We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation (n = 180) and sinus rhythm (n = 762). By multivariable logistic regression analysis, peak VO2 (OR 0.376, 95{\%} CI 0.240-0.588, P <0.0001), O2pulse (VO 2/heart rate, HR) (OR 0.236, 95{\%} CI 0.152-0.366, P <0.0001), VCO2 (OR 3.97, 95{\%} CI 2.163-7.287, P <0.0001), and ventilation (OR 1.38, 95{\%} CI 1.045-1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73{\%}) atrial fibrillation and in 649 of 762 (85{\%}) sinus rhythm patients (P = 0.0002). By multivariable logistic regression analysis, only peak VO2 (OR 0.214, 95{\%} CI 0.155-0.296, P <0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR (P <0.0001) and higher VO2 (P <0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation. Conclusion: In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO2. The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO 2 is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.",
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AU - Agostoni, Piergiuseppe

AU - Emdin, Michele

AU - Corrà, Ugo

AU - Veglia, Fabrizio

AU - Magrì, Damiano

AU - Tedesco, Calogero C.

AU - Berton, Emanuela

AU - Passino, Claudio

AU - Bertella, Erika

AU - Re, Federica

AU - Mezzani, Alessandro

AU - Belardinelli, Romualdo

AU - Colombo, Chiara

AU - La Gioia, Rocco

AU - Vicenzi, Marco

AU - Giannoni, Alberto

AU - Scrutinio, Domenico

AU - Giannuzzi, Pantaleo

AU - Tondo, Claudio

AU - Di Lenarda, Andrea

AU - Sinagra, Gianfranco

AU - Piepoli, Massimo F.

AU - Guazzi, Marco

PY - 2008/10

Y1 - 2008/10

N2 - Aims: The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown. Methods and results: We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation (n = 180) and sinus rhythm (n = 762). By multivariable logistic regression analysis, peak VO2 (OR 0.376, 95% CI 0.240-0.588, P <0.0001), O2pulse (VO 2/heart rate, HR) (OR 0.236, 95% CI 0.152-0.366, P <0.0001), VCO2 (OR 3.97, 95% CI 2.163-7.287, P <0.0001), and ventilation (OR 1.38, 95% CI 1.045-1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73%) atrial fibrillation and in 649 of 762 (85%) sinus rhythm patients (P = 0.0002). By multivariable logistic regression analysis, only peak VO2 (OR 0.214, 95% CI 0.155-0.296, P <0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR (P <0.0001) and higher VO2 (P <0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation. Conclusion: In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO2. The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO 2 is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.

AB - Aims: The influence of permanent atrial fibrillation on exercise tolerance and cardio-respiratory function during exercise in heart failure (HF) is unknown. Methods and results: We retrospectively compared the results of 942 cardiopulmonary exercise tests, performed consecutively at seven Italian laboratories, in HF patients with atrial fibrillation (n = 180) and sinus rhythm (n = 762). By multivariable logistic regression analysis, peak VO2 (OR 0.376, 95% CI 0.240-0.588, P <0.0001), O2pulse (VO 2/heart rate, HR) (OR 0.236, 95% CI 0.152-0.366, P <0.0001), VCO2 (OR 3.97, 95% CI 2.163-7.287, P <0.0001), and ventilation (OR 1.38, 95% CI 1.045-1.821, P = 0.0231) were independently associated with atrial fibrillation. Anaerobic threshold (AT) was identified in 132 of 180 (73%) atrial fibrillation and in 649 of 762 (85%) sinus rhythm patients (P = 0.0002). By multivariable logistic regression analysis, only peak VO2 (OR 0.214, 95% CI 0.155-0.296, P <0.0001) was independently associated with unidentified AT. At AT, atrial fibrillation HF patients had higher HR (P <0.0001) and higher VO2 (P <0.001) compared with sinus rhythm HF patients. Among AT variables, by multivariable logistic regression analysis, only HR was an independent predictor of atrial fibrillation. Conclusion: In HF patients with permanent atrial fibrillation, exercise performance is reduced as reflected by reduced peak VO2. The finding of unidentified AT is associated with a poor performance. In atrial fibrillation patients, VO 2 is higher at AT whereas lower at peak. This last observation raises uncertainties about the use of AT data to define performance and prognosis of HF patients with atrial fibrillation.

KW - Anaerobic threshold

KW - Atrial fibrillation

KW - Cardiopulmonary exercise testing

KW - Heart failure

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