Abstract
Purpose: The aim of the study was to assess the relationship of dehydration, body mass index (BMI) and other indices with the occurrence of atrial fibrillation (AF) in heart failure (HF) patients.Methods: The study included 113 patients [median age 64 years; 57.52% male] hospitalized due to HF. Baseline demographics, body mass analysis, echocardiographic results, key cardiopulmonary exercise test (CPET) parameters, 6 min walk distance (6MWD) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score were assessed.Results: Of all patients, 23 (20.35%) had AF, and 90 (79.65%) had sinus rhythm (SR). Patients with AF were older (med. 66 vs. 64 years; p = 0.039), with higher BMI (32.02 vs. 28.51 kg/m2; p = 0.017) and percentage of fat content (37.0 vs. 27.9%, p = 0.014). They were more dehydrated, with a lower percentage of total body water (TBW%) (45.7 vs. 50.0%; p = 0.022). Clinically, patients with AF had more often higher New York Heart Association (NYHA) class (III vs. II; p < 0.001), shorter 6MWD (median 292.35 vs. 378.4 m; p = 0.001) and a lower KCCQ overall summary score (52.60 vs. 73.96 points; p = 0.002). Patients with AF had significantly lower exercise capacity as measured by peak oxygen consumption (peak VO2) (0.92 vs. 1.26 mL/min, p = 0.016), peak VO2/kg (11 vs. 15 mL/kg/min; p < 0.001), and percentage of predicted VO2max (pp-peak VO2) (62.5 vs 70.0; p=0.010). We also found VE/VCO2 (med. 33.85 vs. 32.20; p = 0.049) to be higher and peak oxygen pulse (8.5 vs. 11 mL/beat; p = 0.038) to be lower in patients with AF than in patients without AF. In a multiple logistic regression model higher BMI (OR 1.23 per unit increase, p < 0.001) and higher left atrial volume index (LAVI) (OR 1.07 per unit increase, p = 0.03), lower tricuspid annular plane systolic excursion (TAPSE) (OR 0.74 per unit increase, p =0.03) and lower TBW% in body mass analysis (OR 0.90 per unit increase, p =0.03) were independently related to AF in patients with HF.Conclusion: Increased volume of left atrium and right ventricular systolic dysfunction are well-known predictors of AF occurrence in patients with HF, but hydration status and increased body mass also seem to be important factors of AF in HF patients.
Highlights
MATERIALS AND METHODSAtrial fibrillation (AF) is one of the most common arrhythmias worldwide
The aim of the study was to assess the relationship of dehydration, body mass index (BMI), and other indices with the occurrence of AND METHODSAtrial fibrillation (AF) in heart failure (HF) patients and to assess the influence of this arrhythmia on exercise capacity assessed by the cardiopulmonary exercise testing (CPET) and 6-min walk test (6MWT) and to clarify the impact of AF on patients’ quality of life assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ)
Patients with AF showed a higher concentration of sodium (Table 6) and uric acid and a significantly higher level of biomarkers associated with inflammation (CRP and hs-C-reactive protein (CRP)) and myocyte stress and injury (NT-proBNP and high-sensitivity cardiac troponin T (hs-cTnT)) than nonAF individuals (Table 6)
Summary
MATERIALS AND METHODSAtrial fibrillation (AF) is one of the most common arrhythmias worldwide. AF is independently associated with increased morbidity and death from chronic diseases, including ischemic stroke (5-fold) [4], dementia and cognitive impairment (2-fold) [5, 6], heart failure (HF) (3-fold increase in the risk of HF and hospitalizations) [7, 8], and all-cause mortality (2-fold) [9,10,11]. The incidence of AF in the HF population rises with the New York Heart Association (NYHA) class (from 4% in NYHA class I to 50% in NYHA class IV) [12], while AF diagnosis in turn predisposes to the development of HF in the future (2- to 3-fold increased risk of incident HF) [8, 11, 12]. Some studies have demonstrated improved quality of life and exercise capacity and/or symptom relief in AF patients when sinus rhythm (SR) has been restored [16, 17]
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