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Published on: July 20, 2022
Prognostic value of cardiopulmonary exercise testing in cardiac patients with atrial fibrillation
Hidekazu Tsuneoka1, Akira Koike, Osamu Nagayama
1Cardiovascular Institute, Tokyo, Japan.
Insights
Cardiopulmonary exercise testing (CPX) reveals different predictors for cardiac events. Peak oxygen uptake (VO2) predicts events in sinus rhythm patients, while the ventilation-to-carbon dioxide output (VE-VCO2) slope is key for atrial fibrillation patients.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Cardiopulmonary exercise testing (CPX) parameters are crucial for predicting cardiac events.
- Previous studies have highlighted the prognostic value of CPX in cardiac patients.
Purpose of the Study:
- To compare the prognostic value of CPX parameters between patients with atrial fibrillation (AF) and sinus rhythm (SR).
- To identify specific CPX metrics that predict cardiac events in each patient group.
Main Methods:
- CPX was performed on 72 AF patients and 478 SR patients.
- Key parameters measured included peak oxygen uptake (VO2), ΔVO2/ΔWR, and VE-VCO2 slope.
- Multivariate Cox proportional hazards analysis was used to assess prognostic value.
Main Results:
- AF patients experienced higher rates of cardiac death and events compared to SR patients.
- Peak VO2 was the sole significant predictor of cardiac death and events in SR patients.
- VE-VCO2 slope was the sole significant predictor of cardiac death and events in AF patients.
Conclusions:
- The VE-VCO2 slope is a strong predictor of future cardiac events in AF patients.
- Peak VO2 is a strong predictor of future cardiac events in SR patients.
- Different CPX parameters hold prognostic significance based on cardiac rhythm.
Abstract:
Parameters obtained from cardiopulmonary exercise testing (CPX) are recognized for their high prognostic value in predicting future cardiac events in cardiac patients. Our group compared the prognostic value of CPX parameters between patients with sinus rhythm (SR) and patients with atrial fibrillation (AF).Peak O2 uptake (VO2), the ratio of the increase in VO2 to the increase in work rate (ΔVO2/ΔWR), and the slope of the increase in ventilation to the increase in CO2 output (VE-VCO2 slope) were obtained from CPX in 72 AF patients and 478 SR patients. The prognostic values of these indices were compared between the two groups.Six cardiac deaths and 25 cardiac events were observed in the AF group and 9 cardiac deaths and 96 cardiac events were observed in the SR group, over a prospective follow-up period of 1,192 days. The percentages of cardiac deaths and cardiac events were higher in the AF group than in the SR group. In a multivariate Cox proportional hazards analysis, peak VO2 was identified as a sole significant predictor of cardiac death and cardiac events in SR patients and VE-VCO2 slope was identified as a sole significant predictor of cardiac death and cardiac events in AF patients.Our results suggest that the VE-VCO2 slope is strongly predictive of future cardiac events in patients with AF and that peak VO2 is strongly predictive of future cardiac events in SR patients.
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