Prognostic Value of Cardiopulmonary Exercise Testing in Cardiac Patients With Atrial Fibrillation

Abstract

SummaryParameters obtained from cardiopulmonary exercise testing (CPX) are recognized for their high prognostic value in predicting future cardiac events in cardiac patients. Our group compared the prognostic value of CPX parameters between patients with sinus rhythm (SR) and patients with atrial fibrillation (AF).Peak O2 uptake (VO2), the ratio of the increase in VO2 to the increase in work rate ( ∆VO2/ ∆WR), and the slope of the increase in ventilation to the increase in CO2 output (VE-VCO2 slope) were obtained from CPX in 72 AF patients and 478 SR patients. The prognostic values of these indices were compared between the two groups.Six cardiac deaths and 25 cardiac events were observed in the AF group and 9 cardiac deaths and 96 cardiac events were observed in the SR group, over a prospective follow-up period of 1,192 days. The percentages of cardiac deaths and cardiac events were higher in the AF group than in the SR group. In a multivariate Cox proportional hazards analysis, peak VO2 was identified as a sole significant predictor of cardiac death and cardiac events in SR patients and VE-VCO2 slope was identified as a sole significant predictor of cardiac death and cardiac events in AF patients.Our results suggest that the VE-VCO2 slope is strongly predictive of future cardiac events in patients with AF and that peak VO2 is strongly predictive of future cardiac events in SR patients. (Int Heart J 2012; 53: 102-107)

Prognostic Prediction of Cardiopulmonary Exercise Test Parameters in Heart Failure Patients With Atrial Fibrillation

“…One previous study has shown that in a multivariate Cox analysis, pVO 2 was identified as a sole significant predictor of cardiac events in HF patients in SR and the VE/VCO 2 slope in AF patients. 38 Our results, however, do not concur with the previous results. In fact, our multivariate Cox analysis (Table 5) showed that when pVO 2 and the VE/VCO 2 slope are analysed together, pVO 2 lost its predictive power (p = 0.280) while the VE/VCO 2 slope remained predictive of the primary outcome (p = 0.001) in the SR group.…”

“…Despite being a seven-year follow-up of patients evaluated for HT in one advanced HF centre, the analysed cohort was not larger than other studies of the relation between HF and AF. 2,36,38 However, the sample size is similar to other studies that highlighted the value of CPET parameters, including for the selection of patients for HT. 8,32,35,44,45 Since patients were referred for a tertiary hospital for the purpose of evaluation with HF team and possible indication…”

Influence of atrial fibrillation on oxygen uptake and exercise tolerance in cardiovascular patients; close association with heart rate response

“…An improvement in physical activity should be regarded as being imperative to the personalization of AF therapy, as symptoms could be determined by the balance between a patient's exercise capacity and daily physical activity. For appropriate personalization of therapy for AF patients, further investigation into exercise physiology in AF is warranted [9,10]. In particular, the effects of heart rate (HR) on exercise capacity, which, in AF patients are complicated, in part due to an exaggerated HR increase during exercise, itself may have a significant impact on exercise tolerance [11,12].…”

Clinical Significance of the Presence of Oscillatory Breathing Both at Rest and During Exercise in Cardiac Patients

“…The peak VO2 was calculated as OSCILLATORY BREATHING AT REST AND DURING EXERCISE an average of the values obtained during the last 15 seconds of incremental exercise. 13) The percentage of peak VO2 was calculated by dividing the measured peak VO2 by the predicted peak VO2. The predicted peak VO2 was determined based on a normal Japanese population.…”