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Impact of atrial fibrillation on rest and exercise haemodynamics in heart failure with mid‐range and preserved ejection fraction
Author(s) -
Kaye David M.,
Silvestry Frank E.,
Gustafsson Finn,
Cleland John G.,
van Veldhuisen Dirk J.,
Ponikowski Piotr,
Komtebedde Jan,
Nanayakkara Shane,
Burkhoff Dan,
Shah Sanjiv J.
Publication year - 2017
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.930
Subject(s) - medicine , cardiology , heart failure , ejection fraction , atrial fibrillation , cardiac index , supine position , sinus rhythm , pulmonary wedge pressure , cardiac output , stroke volume , heart failure with preserved ejection fraction , hemodynamics , arteriovenous oxygen difference
Aims Heart failure with preserved (HFpEF) and mid‐range ejection fraction (HFmrEF) are becoming the most prevalent forms of heart failure. Patients with HFpEF/HFmrEF in atrial fibrillation (AF) have poorer survival and quality of life, but the mechanism underpinning this is unknown. We sought to investigate the influence of AF on the haemodynamic profile of HFpEF/HFmrEF patients at rest and during exercise. Methods and results We invasively measured central haemodynamics at rest and during symptom‐limited supine bicycle exercise in HFpEF/HFmrEF patients, 35 in sinus rhythm and 20 in AF with matched left ventricular ejection fraction. At rest, AF patients had significantly increased pulmonary capillary wedge pressure, lower cardiac index and reduced left ventricular stroke work index, despite similar resting heart rate. Under resting conditions, calculated oxygen consumption and systemic arteriovenous oxygen gradient were not different between the two groups. During supine cycling at similar levels of workload, AF patients exhibited a reduced capacity to increase their oxygen consumption and this was accompanied by a persistently impaired cardiac index and left ventricular stroke work index. Conclusions The adverse interaction of AF and HFpEF/HFmrEF may be accounted for by an adverse impact on left ventricular systolic function and peripheral oxygen kinetics.