Thread by @VerwerftJan

🧵 New paper in Journal of Cardiac Failure
How does atrial fibrillation affect exercise hemodynamics in HFpEF?
🫀🫁🚴 =#CPETecho
We combined CPET with echocardiography to dissect the mechanisms 👇
led by 🌟@S_FoulkesAEP @_Sara_Ferreira @mhaykows 🌟

#HFpEF #AtrialFibrillation

1/8
In a large HFpEF cohort undergoing CPETecho, we compared
• Sinus rhythm
• Paroxysmal AF
• Persistent AF
at the time of exercise testing

2/8🔑 Key finding:
Only persistent #AF was associated with a significantly lower peak VO₂.
Paroxysmal AF behaved much closer to sinus rhythm.

3/8
Why?
The reduction in peak VO₂ in persistent AF was driven primarily by:
⬇️ Peak cardiac output
⬇️ Stroke volume augmentation during exercise
Despite higher HR and similar peripheral O₂ extraction.
#ExercisePhysiology

4/8
Is impaired preload reserve part of the explanation?

5/8
🚫 Figure 4:
Despite worse exercise capacity, persistent AF showed similar
• mPAP
• sPAP
• mPAP/CO slope
across rhythm groups.

6/8
✔ Findings were robust after adjustment for
BMI, medications (incl β-blockers), MR, renal function, and pulmonary hypertension.

7/8🧠 Take-home:
In HFpEF, rhythm at the time of exercise matters.
Rhythm control strategies may therefore be pivotal in optimizing exercise performance and clinical outcomes in patients with HFpEF and AF.
📄 Journal of Cardiac Failure

8/8📄 Read the full paper: Journal of Cardiac Failure
🙏Thanks to an outstanding team, and to the patients and reviewers



#HFpEF #AtrialFibrillation #CPETecho #ExerciseHemodynamics #CardioTwitterdoi.org/10.1016/j.card…

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