Exercise Tolerance and Heart Failure in Patients with Atrial Fibrillation: A Study Using Exercise Stress Echocardiography

2021 Fiscal Year Final Research Report

• Project/Area Number: 19K23932
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Multi-year Fund
• Review Section: 0902:General internal medicine and related fields
• Research Institution: Hokkaido University
• Principal Investigator: TSUJINAGA SHINGO 北海道大学, 医学研究院, 特任助教 (60844743)
• Project Period (FY): 2019-08-30 – 2022-03-31
• Keywords: 運動負荷心エコー図 / 心房細動 / 運動耐容能 / 心肺運動負荷試験

Outline of Final Research Achievements

Atrial fibrillation is an arrhythmia commonly encountered in daily medical practice. The development of atrial fibrillation leads to a loss of mobility due to shortness of breath and eventually to the development of heart failure, which is a life-shortening disease. The mechanism of reduced exercise tolerance caused by atrial fibrillation and factors associated with the development of heart failure have not been elucidated. In this study, we evaluated changes in cardiac morphology and function during exercise in patients with atrial fibrillation using exercise stress echocardiography and cardiopulmonary exercise stress testing. Patients with atrial fibrillation complicated with heart failure had reduced exercise tolerance than patients without heart failure, as well as lower left atrial stretch (strain) at rest and during exercise, and in particular, lower left atrial strain was closely related to heart failure and reduced exercise tolerance.

Free Research Field

心エコー図学

Academic Significance and Societal Importance of the Research Achievements

本研究では、心房細動患者さんを対象に、運動負荷心エコー法や心肺運動負荷試験を用いて、運動時の心臓の形態や機能の変化の評価を行うことで、心不全合併の心房細動患者さんでは、心不全を発症していない患者さんよりも運動能力が低下し、さらには安静時及び運動時の左心房の伸び縮み(ストレイン)が低下し、左心房のストレイン低下は心不全や運動能力の低下と密接に関連することを見出しました。このことは心房細動に対するカテーテルアブレーションなどの積極的かつ有効な治療戦略を策定することやその治療時期タイミングを検討する上で、重要な参考所見になり得ると考えられます。