Impact of atrial fibrillation on rest and exercise haemodynamics in heart failure with mid-range and preserved ejection fraction

Kaye, D. M., Silvestry, F. E., Gustafsson, F., Cleland, J. G. , van Veldhuisen, D. J., Ponikowski, P., Komtebedde, J., Nanayakkara, S., Burkhoff, D. and Shah, S. J. (2017) Impact of atrial fibrillation on rest and exercise haemodynamics in heart failure with mid-range and preserved ejection fraction. European Journal of Heart Failure, 19(12), pp. 1690-1697. (doi: 10.1002/ejhf.930) (PMID:29024227)

[img]
Preview
Text
150058.pdf - Accepted Version

668kB

Abstract

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Kaye, D. M., Silvestry, F. E., Gustafsson, F., Cleland, J. G., van Veldhuisen, D. J., Ponikowski, P., Komtebedde, J., Nanayakkara, S., Burkhoff, D., and Shah, S. J.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:11 October 2017
Copyright Holders:Copyright © 2017 The Authors and European Society of Cardiology
First Published:First published in European Journal of Heart Failure 19(12):1690-1697
Publisher Policy:Reproduced in accordance with the publisher copyright policy

University Staff: Request a correction | Enlighten Editors: Update this record