Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation
Abstract Objective The study aimed to investigate the functional capacity and hemodynamics at rest and during exercise in patients with chronic atrial fibrillation and severe functional symptomatic tricuspid regurgitation (AF-FTR). Background Symptoms and clinical performance of severe AF-FTR mimic...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-021-02094-3 |
| _version_ | 1818928896537526272 |
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| author | Jesper K. Jensen Tor S. Clemmensen Christian A. Frederiksen Joachim Schofer Mads J. Andersen Steen H. Poulsen |
| author_facet | Jesper K. Jensen Tor S. Clemmensen Christian A. Frederiksen Joachim Schofer Mads J. Andersen Steen H. Poulsen |
| author_sort | Jesper K. Jensen |
| collection | DOAJ |
| description | Abstract Objective The study aimed to investigate the functional capacity and hemodynamics at rest and during exercise in patients with chronic atrial fibrillation and severe functional symptomatic tricuspid regurgitation (AF-FTR). Background Symptoms and clinical performance of severe AF-FTR mimic the population of patients with heart failure with preserved ejection fraction (HFpEF). Severe AF-FTR is known to be associated with an adverse prognosis whereas less is reported about the clinical performance including exercise capacity and hemodynamics in patients symptomatic AF-FTR. Methods Right heart catheterization (RHC) at rest and during exercise was conducted in a group of patients with stable chronic AF-TR and compared with a group of patients with HFpEF diagnosed with cardiac amyloid cardiomyopathy (CA). All patients had preserved ejection fraction and no significant left-sided disease. Results Patients with AF-FTR demonstrated a low exercise capacity that was comparable to CA patients (TR 4.9 ± 1.2 METS vs. CA 4. 7 ± 1.5 METS; P = 0.78) with an average peak maximal oxygen consumption of 15 mL/min/kg. Right atrium pressure increased significantly more in the AF-FTR patients as compared to CA patients at peak exercise (25 ± 8 vs 19 ± 9, p < 0.01) whereas PCWP increased significantly to a similar extent in both groups (31 ± 4 vs 31 ± 8 mmHg, p = 0.88). Cardiac output (CO) was significantly lower among AF-FTR at rest as compared to CA patients (3.6 ± 0.9 vs 4.4 ± 1.3 l/min; p < 0.05) whereas both groups demonstrated a poor but comparable CO reserve at peak exercise (7.3 ± 2.9 vs 7.9 ± 3.8 l/min, p = 0.59). Conclusions AF-FTR contributes to the development of advanced heart failure symptoms and poor exercise capacity reflected in increased atrial filling pressures, reduced cardiac output at rest and during exercise sharing common features seen in HFpEF patients with other etiologies. |
| first_indexed | 2024-12-20T03:36:11Z |
| format | Article |
| id | doaj.art-98e118caac7f490b95d35d60bfae1bf2 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-20T03:36:11Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-98e118caac7f490b95d35d60bfae1bf22022-12-21T19:54:52ZengBMCBMC Cardiovascular Disorders1471-22612021-06-0121111010.1186/s12872-021-02094-3Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillationJesper K. Jensen0Tor S. Clemmensen1Christian A. Frederiksen2Joachim Schofer3Mads J. Andersen4Steen H. Poulsen5Department of Cardiology, Aarhus University HospitalDepartment of Cardiology, Aarhus University HospitalDepartment of Cardiology, Aarhus University HospitalMVZ Department Structural Heart Disease, Asklepios Clinic St.GeorgDepartment of Cardiology, Aarhus University HospitalDepartment of Cardiology, Aarhus University HospitalAbstract Objective The study aimed to investigate the functional capacity and hemodynamics at rest and during exercise in patients with chronic atrial fibrillation and severe functional symptomatic tricuspid regurgitation (AF-FTR). Background Symptoms and clinical performance of severe AF-FTR mimic the population of patients with heart failure with preserved ejection fraction (HFpEF). Severe AF-FTR is known to be associated with an adverse prognosis whereas less is reported about the clinical performance including exercise capacity and hemodynamics in patients symptomatic AF-FTR. Methods Right heart catheterization (RHC) at rest and during exercise was conducted in a group of patients with stable chronic AF-TR and compared with a group of patients with HFpEF diagnosed with cardiac amyloid cardiomyopathy (CA). All patients had preserved ejection fraction and no significant left-sided disease. Results Patients with AF-FTR demonstrated a low exercise capacity that was comparable to CA patients (TR 4.9 ± 1.2 METS vs. CA 4. 7 ± 1.5 METS; P = 0.78) with an average peak maximal oxygen consumption of 15 mL/min/kg. Right atrium pressure increased significantly more in the AF-FTR patients as compared to CA patients at peak exercise (25 ± 8 vs 19 ± 9, p < 0.01) whereas PCWP increased significantly to a similar extent in both groups (31 ± 4 vs 31 ± 8 mmHg, p = 0.88). Cardiac output (CO) was significantly lower among AF-FTR at rest as compared to CA patients (3.6 ± 0.9 vs 4.4 ± 1.3 l/min; p < 0.05) whereas both groups demonstrated a poor but comparable CO reserve at peak exercise (7.3 ± 2.9 vs 7.9 ± 3.8 l/min, p = 0.59). Conclusions AF-FTR contributes to the development of advanced heart failure symptoms and poor exercise capacity reflected in increased atrial filling pressures, reduced cardiac output at rest and during exercise sharing common features seen in HFpEF patients with other etiologies.https://doi.org/10.1186/s12872-021-02094-3Atrial fibrillationSecondary tricuspid regurgitationCardiac amyloid cardiomyopathyExercise hemodynamics |
| spellingShingle | Jesper K. Jensen Tor S. Clemmensen Christian A. Frederiksen Joachim Schofer Mads J. Andersen Steen H. Poulsen Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation BMC Cardiovascular Disorders Atrial fibrillation Secondary tricuspid regurgitation Cardiac amyloid cardiomyopathy Exercise hemodynamics |
| title | Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation |
| title_full | Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation |
| title_fullStr | Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation |
| title_full_unstemmed | Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation |
| title_short | Clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation |
| title_sort | clinical performance and exercise hemodynamics in patients with severe secondary tricuspid regurgitation and chronic atrial fibrillation |
| topic | Atrial fibrillation Secondary tricuspid regurgitation Cardiac amyloid cardiomyopathy Exercise hemodynamics |
| url | https://doi.org/10.1186/s12872-021-02094-3 |
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