High Prevalence of Occult Heart Failure With Preserved Ejection Fraction Among Patients With Atrial Fibrillation and Dyspnea
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Atrial fibrillation (AF) is common in patients with heart failure and preserved ejection fraction (HFpEF).1,2 Like people with HFpEF, patients with AF commonly describe exertional dyspnea. Treatments directed at AF are often undertaken by using antiarrhythmic drugs, rate control, or AF ablation with the ultimate goal of improving these symptoms. However, recent data indicate that some patients with apparently lone AF display myocardial abnormalities that persist even when sinus rhythm has been restored, suggesting the coexistence of an underlying cardiomyopathic process.3 Viewed in this light, AF might be conceptualized as a consequence rather than a cause of symptoms of heart failure.
There is little information available regarding the prevalence of HFpEF among patients presenting with dyspnea, normal ejection fraction (EF), and AF. Because history, physical examination, and echocardiography are insensitive to the diagnosis of HFpEF, the only method to accurately determine whether HFpEF is present or absent in this group is to ascertain disease status by using the gold standard of invasive hemodynamic cardiopulmonary exercise testing.4,5
We examined the relationships between AF and HFpEF among consecutive patients presenting with …