Abstract
Abstract Background: Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients. Objective: To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection. Methods: Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant. Results: There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group. Conclusion: Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.
Highlights
Heart failure (HF) and atrial fibrillation (AF) often coexist,[1] with Atrial fibrillation (AF) occurring in some reports in more than 50% of heart failure (HF) patients, and HF in more than one-third of AF patients.[2]
There were no significant differences for sodium and NTproBNP, but glomerular filtration rate (GFR) values were lower in the AF group (65.03 ± 29.05 vs 76.84 ± 30.20, p = 0.012)
The Heart Failure Survival Score (HFSS),[21] Sodium,[22] NT-proBNP,[23,24,25] right ventricular dysfunction,[18] lower left ventricular ejection fraction (LVEF),[19,20] cardiopulmonary exercise test (CPET) duration, HHR1,26 and initial and maximal systolic blood pressure (SBP) during CPET27 were included in this group, with all of them being formerly described as prognostic markers in HF patients
Summary
Heart failure (HF) and atrial fibrillation (AF) often coexist,[1] with AF occurring in some reports in more than 50% of HF patients, and HF in more than one-third of AF patients.[2] Since the burden of each is growing, they have been called the two new epidemics of cardiovascular (CV) disease.[3]. The presence of AF in HF patients is associated with adverse hemodynamic consequences, which may exacerbate HF, increasing morbidity and mortality.[4,5,6]. Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients
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