Author + information
- Rosita Zakeri,
- Barry Borlaug,
- Steven McNulty,
- Selma Mohammed,
- Gregory Lewis,
- Marc Semigran,
- Anita Deswal,
- Martin LeWinter,
- Adrian Hernandez,
- Eugene Braunwald and
- Margaret Redfield
Atrial fibrillation (AF) is common in diastolic heart failure (DHF). We hypothesized that AF may adversely impact exercise capacity in DHF. The Heart Failure Clinical Research Network has completed the RELAX trial: a multicenter randomized trial testing the impact of sildenafil® on peak VO2 in DHF.
RELAX enrolled 216 DHF patients: 79 (37%) had AF, 124 (57%) were in sinus rhythm (SR), 13 were in other rhythms. Participants underwent a baseline cardiopulmonary exercise test (CPXT), echo, biomarker and rhythm status assessment prior to randomization.
See table. DHF patients with AF were older than those in SR but had similar symptom severity (NYHA class), co-morbidities and renal function. Despite comparable LV dimensions and LV mass index, AF was associated with worse systolic (lower EF and cardiac index) and diastolic (shorter deceleration time, higher right atrial and pulmonary artery systolic pressures, larger left atrial volume index) function compared to SR, though E/e’ was similar between groups. AF patients also had more severe neurohumoral activation. Peak VO2 was significantly reduced in AF, despite similar rest and peak heart rates and beta-blocker use (80% AF vs 73% SR, p=0.30) to SR patients. AF was associated with reduced peak VO2 even after adjustment for age and sex (p=0.04).
AF identifies a DHF cohort with more advanced disease and significantly reduced exercise capacity. Whether AF is a marker or mediator of DHF progression warrants further investigation.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Insights into Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1220-281
- 2013 American College of Cardiology Foundation