HUNG-JUI CHUANGLin, Lung-ChunLung-ChunLinYu, An-LiAn-LiYuYEN BIN LIULI-TING HOLIAN-YU LINHUI-CHUN HUANGYI-LWUN HOWEN-JONE CHENLING-PING LAISSU-YUAN CHENCHIH-CHIEH YU2024-07-292024-07-292024-04-1615475271https://pubmed.ncbi.nlm.nih.gov/38614190/https://scholars.lib.ntu.edu.tw/handle/123456789/720027Background: Exercise intolerance is a common symptom associated with atrial fibrillation (AF). However, echocardiographic markers that can predict impaired exercise capacity are lacking. Objective: This study aimed to investigate the association between echocardiographic parameters and exercise capacity assessed by cardiopulmonary exercise testing in patients with AF. Methods: This single-center prospective study enrolled patients with AF who underwent echocardiography and cardiopulmonary exercise testing to evaluate exercise capacity at a tertiary center for AF management from 2020 to 2022. Patients with valvular heart disease, reduced left ventricular ejection fraction, or documented cardiomyopathy were excluded. Results: Of the 188 patients, 134 (71.2%) exhibited impaired exercise capacity (peak oxygen consumption ≤85%), including 4 (2.1%) having poor exercise capacity (peak oxygen consumption <50%). Echocardiographic findings revealed that these patients had an enlarged left atrial end-systolic diameter (LA); smaller left ventricular end-diastolic diameter (LVEDD); and increased relative wall thickness, tricuspid regurgitation velocity, and LA/LVEDD and E/e' ratios. In addition, they exhibited lower peak systolic velocity of the mitral annulus and LA reservoir strain. In the multivariate regression model, LA/LVEDD remained the only significant echocardiographic parameter after adjustment for age, sex, and body mass index (P = .020). This significance persisted even after incorporation of heart rate reserve, N-terminal pro-B-type natriuretic peptide level, and beta-blocker use into the model. Conclusion: In patients with AF, LA/LVEDD is strongly associated with exercise capacity. Further follow-up and validation are necessary to clarify its clinical implications in patient care.enfalseAtrial fibrillationCardiopulmonary exerciseEjection fractionExercise capacityHeart failureLeft atrioventricular coupling index[SDGs]SDG3journal article10.1016/j.hrthm.2024.04.048386141902-s2.0-85192559775