Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic (M.B.E., B.L.W., K.T., Y.W., E.D., W.J., O.W., L.C.).
Division of Cardiology, Department of Medicine, Weill Cornell Medical College, Education City, Doha, Qatar (M.B.E., C.A.K., N.A.).
Circ Heart Fail. 2021 Feb;14(2):e007451. doi: 10.1161/CIRCHEARTFAILURE.120.007451. Epub 2021 Jan 22.
In heart failure (HF) with sinus rhythm, resting and exercise heart rates correlate with exercise capacity and mortality. However, in HF with atrial fibrillation (AF), this correlation is unknown. Our aim is to investigate the association of resting and exercise ventricular rates (VRs) with exercise capacity and mortality in HF with AF.
We identified 903 patients with HF and AF referred for cardiopulmonary stress testing. AF was defined as history of AF and AF during cardiopulmonary stress testing. We constructed multivariable models to evaluate the association of resting VR, peak exercise VR, VR reserve (peak VR-resting VR), and chronotropic index with (1) peak oxygen consumption (PVO) ≤18 mL/kg per minute, (2) continuous PVO, and (3) 10-year all-cause mortality.
Median (25th-75th percentile) age was 60 (52-67) years, left ventricular ejection fraction was 25 (15-50)%, and 76.1% were males. Patients with lower (quartile 1) compared with higher (quartile 4) peak VR, VR reserve, and chronotropic index were more likely to have PVO ≤18 mL/kg per min (adjusted odds ratio [95% CI]: 14.92 [8.07-27.58], 24.60 [12.36-48.98], and 22.31 [11.24-44.27], respectively), and higher all-cause mortality (adjusted hazard ratio [95% CI]: 2.56 [1.62-4.04], 2.29 [1.47-3.59], and 2.30 [1.51-3.49], respectively). For every 10 beats per minute increase in VR reserve, PVO increased by 1.05 mL/kg per minute (B-coefficient [95% CI]: 1.05 [0.94-1.15]) and mortality decreased by 12% (adjusted hazard ratio [95% CI]: 0.88 [0.83-0.94]). Resting VR was associated with PVO (B-coefficient [95% CI]: -0.46 [-0.70 to -0.23]) but not mortality (adjusted hazard ratio [95% CI]: 0.97 [0.88-1.06]).
In patients with HF and AF, higher resting VR and lower peak exercise VR, VR reserve, and chronotropic index were all associated with worse peak exercise capacity, but only lower exercise VR parameters were associated with higher mortality. Dedicated studies are needed to gauge whether modulating exercise VR enhances exercise performance and outcomes.
在窦性心律心力衰竭（HF）中，静息和运动时的心率与运动能力和死亡率相关。然而，在心房颤动（AF）的 HF 中，这种相关性尚不清楚。我们的目的是研究在 AF 合并 HF 患者中，静息和运动时心室率（VR）与运动能力和死亡率的关系。
我们纳入了 903 例因心肺压力测试而转诊的 HF 合并 AF 患者。AF 定义为既往有 AF 和心肺压力测试期间有 AF。我们构建了多变量模型，以评估静息 VR、峰值运动 VR、VR 储备（峰值 VR-静息 VR）和变时指数与（1）峰值耗氧量（PVO）≤18mL/kg/分钟，（2）连续 PVO，和（3）10 年全因死亡率之间的关系。
中位（25 分位-75 分位）年龄为 60（52-67）岁，左心室射血分数为 25（15-50）%，76.1%为男性。与较高（四分位 4）相比，较低（四分位 1）峰值 VR、VR 储备和变时指数的患者更有可能出现 PVO≤18mL/kg/分钟（校正优势比[95%CI]：14.92[8.07-27.58]，24.60[12.36-48.98]和 22.31[11.24-44.27]），全因死亡率更高（校正风险比[95%CI]：2.56[1.62-4.04]，2.29[1.47-3.59]和 2.30[1.51-3.49]）。VR 储备每增加 10 次/分钟，PVO 增加 1.05mL/kg/分钟（B 系数[95%CI]：1.05[0.94-1.15]），死亡率降低 12%（校正风险比[95%CI]：0.88[0.83-0.94]）。静息 VR 与 PVO 相关（B 系数[95%CI]：-0.46[-0.70 至-0.23]），但与死亡率无关（校正风险比[95%CI]：0.97[0.88-1.06]）。
在 HF 合并 AF 患者中，较高的静息 VR 和较低的峰值运动 VR、VR 储备和变时指数均与较差的峰值运动能力相关，但只有较低的运动 VR 参数与较高的死亡率相关。需要专门的研究来评估调节运动 VR 是否能提高运动表现和结局。
