Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients

Pardaens, Karel; Cleemput, Johan Van; Vanhaecke, Johan; Fagard, Robert

doi:10.1136/hrt.78.6.564

Cited by 92 publications

(76 citation statements)

References 30 publications

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“…AF interferes with endothelial function (10,27) and exercise capacity (9,18,19,24), and a pathophysiological link seems to exist between the two variables (10). Our results have provided evidence that sinus rhythm conversion restores endothelial function in patients with lone AF and is partially effective (hypertension) or ineffective (diabetes) in those with comorbidities that cause endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Endothelial dysfunction and exercise performance in lone atrial fibrillation or associated with hypertension or diabetes: different results with cardioversion

Guazzi¹,

Belletti²,

Bianco³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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Endothelial dysfunction and underperfusion of exercising muscle contribute to exercise intolerance, hyperventilation, and breathlessness in atrial fibrillation (AF). Cardioversion (CV) improves endothelial function and exercise performance. We examined whether CV is equally beneficial in diabetes and hypertension, diseases that cause endothelial dysfunction and are often associated with AF. Cardiopulmonary exercise and pulmonary and endothelial (brachial artery flow-mediated dilation) function were tested before and after CV in patients with AF alone (n ϭ 18, group 1) or AF with hypertension (n ϭ 19, group 2) or diabetes (n ϭ 19, group 3). Compared with group 1, peak exercise workload, O2 consumption (V O2), O2 pulse, aerobic efficiency (⌬V O2/⌬WR), and ratio of brachial diameter changes to flow changes (⌬D/⌬F) were reduced in group 2 and, to a greater extent, in group 3; exercise ventilation efficiency (V E/V CO2 slope) and dead space-to-tidal volume ratio (VD/VT) were similar among groups. CV had less effect on peak workload (ϩ7% vs. ϩ18%), peak V O2 (ϩ12% vs. ϩ17%), O2 pulse (ϩ33% vs. ϩ50%), ⌬V O2/⌬WR (ϩ7% vs. ϩ12%), V E/V CO2 slope (Ϫ6% vs. Ϫ12%), ⌬D/⌬F (ϩ7% vs. ϩ10%), and breathlessness (Borg scale) in group 2 than in group 1 and was ineffective in group 3. The antioxidant vitamin C, tested in eight additional patients in each cohort, improved flow-mediated dilation in groups 1 and 2 before, but not after, CV and was ineffective in group 3, suggesting that the oxidative injury is least in lone AF, greater in hypertension with AF, and greater still in diabetes with AF. Comorbidities that impair endothelial activity worsen endothelial dysfunction and exercise intolerance in AF. The advantages of CV appear to be inversely related to the extent of the underlying oxidative injury.arrhythmias; endothelium; exercise ATRIAL FIBRILLATION (AF) impairs endothelial function and downregulates nitric oxide (NO) production (3, 10, 27). Exercise correlates of these dysfunctions are underperfusion of working muscle, hyperventilation, and breathlessness (10). These findings are consistent with the concept that, during exercise, an endothelium-mediated vasodilation modulates neurogenic vasoconstriction, increases arterial conductance, and upregulates muscle perfusion (6,12,16). Conversion to sinus rhythm [i.e., cardioversion (CV)] is beneficial in this respect (10). Irregular pulsatile blood flow in AF may impair the endothelial responsiveness to vascular shear stress, and loss of the cyclic stretch of atrial endocardial cells may decrease expression of NO synthase (3). Restoration of a regular flow regimen and atrial contactile activity with CV normalizes the endothelial physiology.Hypertension and diabetes cause endothelial dysfunction (13,20,23,26). Because AF is not uncommonly associated with high blood pressure and diabetes, we considered the pathophysiological and clinical significance of this association to investigate whether the improvement of endothelial function with CV, its exercise pathophysiological correlates, ...

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Section: Discussionmentioning

confidence: 99%

Endothelial dysfunction and exercise performance in lone atrial fibrillation or associated with hypertension or diabetes: different results with cardioversion

Guazzi¹,

Belletti²,

Bianco³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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show abstract

“…AF is associated with significant morbidity and mortality [2]. There is a 5-fold increase in the risk of stroke [3], a decline in quality of life [4][5][6] and functional status [7][8][9][10]. The rate of AF-related hospitalizations is projected to rise 2-3 fold in the coming years [11].…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation practice patterns among cardiac electrophysiologists and cardiologists

Teme

Goldberger²

2014

Cardiol J

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“…Actually, patients with chronic heart failure and atrial fibrillation in whom LA diastolic function is seriously impaired, have lower exercise capacity than those with sinus rhythm. 29 In the present study, neither LV functional parameters nor transmitral flow parameters, shown in Table 1, correlated with the hemodynamic parameters during pacing-tachycardia, although IRT, one of the LV diastolic functional parameters, roughly correlated with exercise capacity. On the other hand, PVS1, but not PVS2, PVD or PVA, correlated with the degree of elevation in pulmonary circulatory pressure during pacingtachycardia (Table 2).…”

Section: La Diastolic Function and Pulmonary Circulatory Pressure Durmentioning

confidence: 41%

Left Atrial Function Preserves Pulmonary Circulatory Pressure During Pacing-Tachycardia and Contributes to Exercise Capacity in Patients With Idiopathic Dilated Cardiomyopathy in Sinus Rhythm, Whose Exercise is Limited by Dyspnea.

Sasaki

Kubo²,

Miyamoto³

et al. 2002

Circ J

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hronic left heart failure is characterized by left ventricular (LV) dysfunction and impaired exercise capacity. The degree of the latter is classified by the peak oxygen consumption (V • O2) measured in an exercise tolerance test. Neither the common hemodynamic parameters nor those of LV systolic function at rest, however, allow precise prediction of the exercise capacity of patients with chronic left heart failure. 1,2 Pulmonary hypertension, 3 residual peripheral dysfunction, such as vasodilatory dysfunction or intrinsic muscle dysfunction, 4-7 have been reported to limit the exercise capacity of patients with chronic left heart failure. Recently, it has been shown that LV diastolic function contributes to exercise capacity; 8-11 impaired LV diastolic function leads to an elevation of the LV end-diastolic pressure during tachycardia, resulting in pulmonary circulatory congestion, which is in turn Circulation Journal Vol.66, October 2002 closely related to exercise-induced dyspnea. 12 The significance of left atrial (LA) function in relation to exercise capacity has been reported in patients with recent myocardial infarction, 13 and in those with hypertrophic cardiomyopathy. 14 It has been reported that LA dysfunction is present in patients with LV diastolic dysfunction 15 or idiopathic dilated cardiomyopathy (DCM), 16,17 and the relation between LA systolic function and exercise capacity has been demonstrated in patients with DCM. 18 However, it was not reported which function of the LA, active relaxation, conduit, booster pump or reservoir, relates to exercise capacity in patients with DCM. The aim of this study was to determine whether LA diastolic function contributes to exercise capacity and to assess the importance of LA function in preserving pulmonary circulatory pressure during tachycardia in patients with DCM. Methods SubjectsWe studied 32 patients with chronically stable heart failure and DCM in sinus rhythm who had (1) dyspnea or fatigue on exercise, (2) a dilated LV with an LV end-diastolic volume index (LVEDVI) of >90 ml/m 2 and mild or no mitral regurgitation on diagnostic left ventriculography, (3) LV ejection fraction <50 % on echocardiography, and (4) Received February 20, 2002; revised manuscript received July 5, 2002; accepted July 22, 2002 The aim of this study was to determine whether left atrial (LA) function contributes to pulmonary circulatory pressure during pacing-tachycardia and exercise capacity in patients with idiopathic dilated cardiomyopathy (DCM). Thirty-two patients with DCM and in sinus rhythm had limited exercise capacity because of dyspnea. The correlation between peak oxygen consumption (V • O2) and the variables of cardiac function by cardiac catheterization and 2-dimensional, Doppler echocardiography, and plasma neurohumoral factor levels was tested, as was the correlation between non-invasive LA functional parameters and pulmonary circulatory pressure during pacingtachycardia. A significant correlation was observed between VCirc J 2002; 66: 937 -942 (• O2 and LA dim...

show abstract

Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients

Cited by 92 publications

References 30 publications

Endothelial dysfunction and exercise performance in lone atrial fibrillation or associated with hypertension or diabetes: different results with cardioversion

Endothelial dysfunction and exercise performance in lone atrial fibrillation or associated with hypertension or diabetes: different results with cardioversion

Atrial fibrillation practice patterns among cardiac electrophysiologists and cardiologists

Left Atrial Function Preserves Pulmonary Circulatory Pressure During Pacing-Tachycardia and Contributes to Exercise Capacity in Patients With Idiopathic Dilated Cardiomyopathy in Sinus Rhythm, Whose Exercise is Limited by Dyspnea.

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