Predicting impaired cardiopulmonary exercise capacity in patients with atrial fibrillation using a simple echocardiographic marker

Hung-Jui Chuang; Lung-Chun Lin; An-Li Yu; Yen-Bin Liu; Lian-Yu Lin; Hui-Chun Huang; Li-Ting Ho; Ling-Ping Lai; Wen-Jone Chen; Yi-Lwung Ho; Ssu-Yuan Chen; Chih-Chieh Yu

doi:10.1016/j.hrthm.2024.04.048

Predicting impaired cardiopulmonary exercise capacity in patients with atrial fibrillation using a simple echocardiographic marker

Heart Rhythm. 2024 Apr 16:S1547-5271(24)02375-0. doi: 10.1016/j.hrthm.2024.04.048. Online ahead of print.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
² Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-chu Branch, Hsinchu, Taiwan.
⁴ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
⁵ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Division of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital and Fu Jen Catholic University School of Medicine, New Taipei City, Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: ccyu2014@ntu.edu.tw.

PMID: 38614190
DOI: 10.1016/j.hrthm.2024.04.048

Abstract

Background: Exercise intolerance is a common symptom associated with atrial fibrillation (AF). However, echocardiographic markers that can predict impaired exercise capacity are lacking.

Objective: This study aimed to investigate the association between echocardiographic parameters and exercise capacity assessed by cardiopulmonary exercise testing in patients with AF.

Methods: This single-center prospective study enrolled patients with AF who underwent echocardiography and cardiopulmonary exercise testing to evaluate exercise capacity at a tertiary center for AF management from 2020 to 2022. Patients with valvular heart disease, reduced left ventricular ejection fraction, or documented cardiomyopathy were excluded.

Results: Of the 188 patients, 134 (71.2%) exhibited impaired exercise capacity (peak oxygen consumption ≤85%), including 4 (2.1%) having poor exercise capacity (peak oxygen consumption <50%). Echocardiographic findings revealed that these patients had an enlarged left atrial end-systolic diameter (LA); smaller left ventricular end-diastolic diameter (LVEDD); and increased relative wall thickness, tricuspid regurgitation velocity, and LA/LVEDD and E/e' ratios. In addition, they exhibited lower peak systolic velocity of the mitral annulus and LA reservoir strain. In the multivariate regression model, LA/LVEDD remained the only significant echocardiographic parameter after adjustment for age, sex, and body mass index (P = .020). This significance persisted even after incorporation of heart rate reserve, N-terminal pro-B-type natriuretic peptide level, and beta-blocker use into the model.

Conclusion: In patients with AF, LA/LVEDD is strongly associated with exercise capacity. Further follow-up and validation are necessary to clarify its clinical implications in patient care.

Keywords: Atrial fibrillation; Cardiopulmonary exercise; Ejection fraction; Exercise capacity; Heart failure; Left atrioventricular coupling index.