Abstract 14017: Prognostic Impact of Peak Heart Rate During Exercise in Atrial Fibrillation

Abstract

Background and Aim: Heart rate (HR) during exercise is known to be associated with cardiovascular morbidity/mortality in sinus rhythm (SR). However, the relationship between HR profile during exercise and cardiovascular prognosis remain unknown well in patients with atrial fibrillation (AF). We previously reported that peak VO2 but not resting HR is an independent predictor for future heart failure (HF) events in patients with AF. The aim of this study was to investigate the relationships between HR profile during exercise and future heart failure (HF) events in patients with AF and those with SR simultaneously. Methods: We used the cohort from the single-hospital database between 2004 and 2013 (N=22,230). Of the total, 2,231 patients (AF; N=321, SR; N=1910) who underwent symptom-limited cardiopulmonary exercise testing were analyzed. HF events were defined as either hospitalization for HF or death from HF. They were categorized according to the quartiles of peak HR in each rhythm. Results: Significant positive relationships between peak HR quartiles and peak VO2 were observed in both groups (AF: p for trend <0.001, SR: p for trend <0.001). Peak HR quartiles were also apparently negatively associated with the incidence of HF events in both groups (Figure). In univariate analysis for HF events, peak HR was significantly related to HF events in both rhythms. Multivariate analysis showed that peak HR was a statistically significant predictor for HF events in the AF group even after adjusted for age, use of HR lowering drugs, left ventricular ejection fraction, organic heart disease and eGFR. However, in the SR group, predictive power of peak HR was weakened after the same adjustment. Conclusion: It was suggested that peak HR is an independently strong predictor for future HF events in patients with AF.