ABC | Volume 114, Nº2, February 2020

Original Article Gonçalves et al. Prediction of CPET in HF patients with AF Arq Bras Cardiol. 2020; 114(2):209-218 1. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. 1982;306(17):1018-22. 2. Santhanakrishnan R, Wang N, Larson MG, Magnani JW, McManus DD, Lubitz SA, et al. Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction. Circulation. 2016;133(5):484-92. 3. Braunwald E. Cardiovascular medicine at the turn of the millennium: triumphs,concerns,andopportunities.NEngl JMed.1997;337(19):1360-9. 4. Pocock SJ, Wang D, Pfeffer MA, Yusuf S, McMurray JJ, Swedberg KB, et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2006;27(1):65-75. 5. Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 1998;32(3):695-703. 6. Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN. The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT Studies. The V-HeFT VA Cooperative Studies Group. Circulation. 1993;87(6 Suppl):VI102-10. 7. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35(1):1-23. 8. Butler J, Khadim G, Paul KM, Davis SF, Kronenberg MW, Chomsky DB, et al. Selection of patients for heart transplantation in the current era of heart failure therapy. J Am Coll Cardiol. 2004;43(5):787-93. 9. Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation. 1997;95(12):2660-7. 10. Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 Focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2016;133(24):e694-711. 11. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29-36. 12. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920-5. 13. van Veldhuisen DJ, Boomsma F, de Kam PJ, Man in’t Veld AJ, Crijns HJ, Hampton JR, et al. Influence of age on neurohormonal activation and prognosis in patients with chronic heart failure. Eur Heart J. 1998;19(5):753-60. 14. Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993;88(1):107-15. 15. Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000;35(3):681-9. 16. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;38(4):955-62. References for HT or mechanical circulatory support, these patients may not be representative of the older or with higher comorbidities HF community, who are not candidate for advanced HF treatment. Conclusions Despite AF carries a worse prognosis for the HF patients, the current cut-off of pVO 2 for HT selection can precisely stratify this group of high-risk patients. The findings from the present study suggest that HF patients with AF and a CPET under the current cut-off of pVO 2 for HT selection should be quickly referred for HT or mechanical circulatory support, since medical treatment is associated with negative outcomes in a 1-year period, with a higher PPV than patients in SR. In addition, pVO 2 cut-off seems to have higher PPV than VE/VCO 2 slope cut-off for the prediction of the primary outcome in HF patients with AF. Author contributions Conception and design of the research: Gonçalves AV, Pereira-da-Silva T, Soares R; Acquisition of data: Pereira-da- Silva T, Soares R, Feliciano J, Moreira RI, Rio P; Analysis and interpretation of the data, Statistical analysis andWriting of the manuscript: Gonçalves AV; Critical revision of the manuscript for intellectual content: Pereira-da-Silva T, Soares R, Abreu A, Ferreira RC. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Centro Hospitalar Lisboa Central under the protocol number CA2257. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 216