title: Impact of BNP level and peak VO2on future heart failure events: comparison between sinus rhythm and atrial fibrillation.
abstract: This study aimed to examine the discrete impacts of peak oxygen consumption (VO2) and brain natriuretic peptide (BNP) levels on future heart failure (HF) events in sinus rhythm (SR) and atrial fibrillation (AF). A total of 1447 patients who underwent symptom-limited cardiopulmonary exercise testing and whose BNP values were determined simultaneously were analysed (SR, N = 1151 and AF, N = 296). HF events were defined as HF hospitalization or HF death. Over a mean follow-up period of 1472 days, 140 HF events were observed. A high BNP value (dichotomized by median value) was independently associated with HF events in SR (HR 8.08; 95 % CI 4.02-16.26; p < 0.0001), but not in AF patients (HR 1.97; 95 % CI 0.91-4.28; p = 0.087) with a significant interaction between the rhythms. By contrast, low-peak VO2was independently associated with HF events in both rhythms (AF; HR 5.81; 95 % CI 1.75-19.30; p = 0.004, SR; HR 2.04; 95 % CI 1.19-3.49; p = 0.009), with a marginal interaction between them. In bivariate Cox models, low-peak VO2had much stronger predictive power for HF events than high-BNP in AF, whereas high-BNP was more powerful than low-peak VO2in SR. The prognostic value of BNP and peak VO2for future HF events seemed to be different between SR and AF.
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan. kimuchi@nms.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Semba
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.affiliation: Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takai
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.affiliation: Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D001146:Arrhythmia, Sinus / Q000150:complications*; D001281:Atrial Fibrillation / Q000150:complications*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Atrial fibrillation; Brain natriuretic peptide; Peak VO2; Sinus rhythm