The role of cardiopulmonary exercise testing in risk stratification and prognosis of atrial fibrillation: a scoping review of the literature

Cardiopulmonary exercise testing (CPET) is a significant tool for evaluating exercise capacity in healthy individuals and in various pulmonary and cardiovascular conditions, quantifying symptoms and predicting outcomes. Atrial fibrillation (AF) poses a significant burden on patients and health systems; a research marathon is ongoing for discovering the pathophysiologic substrate, natural history, prognostic tools and optimal treatment strategies for AF. Among the plethora of variables measured during CPET, there is a series of parameters of interest concerning AF. We conducted a scoping review aiming to identify significant CPET-related parameters linked to AF, as well as indicate the impact of other cardiac disease-related variables. We searched PubMed from its inception to 12 January 2022 for reports underlining the contribution of CPET in the assessment of patients with AF. Only clinical trials, observational studies and systematic reviews were included, while narrative reviews, expert opinions and other forms of manuscripts were excluded. In our scoping review, we report a group of heterogeneous, thus noteworthy parameters relevant to the potential contribution of CPET in AF. CPET helps phenotype AF populations, evaluates exercise capacity after cardioversion or catheter ablation, and assesses heart rate response to exercise; peak VO₂ and VE/VCO₂, commonly measured indices during CPET, also serve as prognostic tools in patients with AF and heart failure. CPET seems to hold a clinically important predictive value for future cardiovascular events both in patients with pre-existing cardiac conditions and in healthy individuals. CPET variables may play a fundamental role in the prediction of future AF-related events.

心肺运动试验（Cardiopulmonary exercise testing, CPET）是评估健康个体及各类肺、心血管疾病患者运动耐量、量化症状并预测转归的重要工具。心房颤动（Atrial fibrillation, AF）对患者及医疗系统造成沉重负担，目前针对其病理生理基质、自然病程、预后评估工具及最优治疗策略的研究正全面推进。在CPET检测的众多变量中，存在一系列与心房颤动相关的潜在关键参数。本研究开展了一项范围综述（scoping review），旨在明确与CPET相关的、与心房颤动存在关联的重要参数，并阐明其他心脏疾病相关变量的影响。本研究检索了PubMed自建库至2022年1月12日的文献，筛选出强调CPET在心房颤动患者评估中价值的报道，仅纳入临床试验、观察性研究及系统综述，排除叙述性综述、专家意见及其他类型手稿。在本次范围综述中，我们报道了一系列异质性较强、因此具有重要研究价值的、与CPET在心房颤动诊疗中潜在作用相关的参数。CPET可用于对心房颤动人群进行表型分型、评估心脏复律或导管消融术后的运动耐量，并评价运动时的心率反应；CPET中常用的检测指标峰值摄氧量（peak VO₂）与VE/VCO₂比值，同样可作为心房颤动合并心力衰竭患者的预后评估工具。无论对于合并基础心脏疾病的患者还是健康个体，CPET似乎均对未来心血管不良事件具有重要的临床预测价值。CPET相关参数可能在预测未来心房颤动相关不良事件中发挥核心作用。