Trial reportCirculation. Heart failure2014
Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study.
Trial report in Circulation. Heart failure, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00763867 (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure), which is not on this map. Cited by 72 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure (RELAX)
Who cites it
72 citing papers in PubMed, 153 citations in OpenAlex.
- Burden of Potentially Undiagnosed Heart Failure With Preserved Ejection Fraction in Atrial Fibrillation and Effects of Catheter Ablation: Insights From CABANA.Journal of the American Heart Association · 2026Trial
- Physical Activity, Quality of Life, and Biomarkers in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction (from the NEAT-HFpEF Trial).The American journal of cardiology · 2019Trial
- High-sensitivity C-reactive protein in heart failure with preserved ejection fraction.PloS one · 2018Trial
- Atrial Fibrillation and HFrEF: Cause, Consequence, or Both?Biomedicines · 2026Review
- Heart failure with preserved ejection fraction (HFpEF): Diagnosis and management for the general physician.Clinical medicine (London, England) · 2026Review
- The clinical pathophysiology of atrial fibrillation: outstanding questions from bedside to bench and back.Physiological reviews · 2026Review
- Effect of SGLT2 Inhibitors on the Efficacy of First-Time Pulmonary Vein Isolation and Clinical Course of Patients with Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation.Journal of cardiovascular development and disease · 2026Article
- Preserved Ejection, Lost Rhythm: A Narrative Review of the Pathophysiology and Management of Heart Failure with Preserved Ejection Fraction and Concomitant Atrial Fibrillation.Journal of clinical medicine · 2026Review
- Mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF).Heart failure reviews · 2025Review
- Circulating collagen type I fragments as specific biomarkers of cardiovascular outcome risk: Where are the opportunities?Matrix biology : journal of the International Society for Matrix Biology · 2025Review
- Long-term impact of atrial fibrillation catheter ablation on heart failure with preserved ejection fraction.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Article
- The role of estrogen in the sex difference for the risk factors of heart failure with preserved ejection fraction.Biology direct · 2025Review
- The impact of atrial fibrillation on oxygen uptake and haemodynamics in patients with heart failure: a systematic review and meta-analysis.European heart journal open · 2025Article
- Collagen type V, interstitial fibrosis and the substrate for atrial fibrillation.International journal of cardiology. Heart & vasculature · 2024Article
- Exercise echocardiography to assess left atrial function in patients with symptomatic AF.International journal of cardiology. Heart & vasculature · 2024Article
- Ablation for atrial fibrillation improves the outcomes in patients with heart failure with preserved ejection fraction.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Exercise capacity and risk of incident atrial fibrillation in healthy adults.The Korean journal of internal medicine · 2023Article
- A review of the impact, pathophysiology, and management of atrial fibrillation in patients with heart failure with preserved ejection fraction.American heart journal plus : cardiology research and practice · 2023Review
- Association of complication of type 2 diabetes mellitus with hemodynamics and exercise capacity in patients with heart failure with preserved ejection fraction: a case-control study in individuals aged 65-80 years.Cardiovascular diabetology · 2023Article
- Effect of Caffeine Consumption on Cardiovascular Disease: An Updated Review.Pharmaceutical medicine · 2023Review
12 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundAtrial fibrillation (AF) is common among patients with heart failure and preserved ejection fraction (HFpEF), but its clinical profile and impact on exercise capacity remain unclear. RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF) was a multicenter randomized trial testing the impact of sildenafil on peak VO2 in stable outpatients with chronic HFpEF. We sought to compare clinical features and exercise capacity among patients with HFpEF who were in sinus rhythm (SR) or AF. METHODS AND
resultsRELAX enrolled 216 patients with HFpEF, of whom 79 (37%) were in AF, 124 (57%) in SR, and 13 in other rhythms. Participants underwent baseline cardiopulmonary exercise testing, echocardiogram, biomarker assessment, and rhythm status assessment before randomization. Patients with AF were older than those in SR but had similar symptom severity, comorbidities, and renal function. β-blocker use and chronotropic indices were also similar. Despite comparable left ventricular size and mass, AF was associated with worse systolic (lower EF, stroke volume, and cardiac index) and diastolic (shorter deceleration time and larger left atria) function compared with SR. Pulmonary artery systolic pressure was higher in AF. Patients with AF had higher N-terminal pro-B-type natriuretic peptide, aldosterone, endothelin-1, troponin I, and C-telopeptide for type I collagen levels, suggesting more severe neurohumoral activation, myocyte necrosis, and fibrosis. Peak VO2 was lower in AF, even after adjustment for age, sex, and chronotropic response, and VE/VCO2 was higher.
conclusionsAF identifies an HFpEF cohort with more advanced disease and significantly reduced exercise capacity. These data suggest that evaluation of the impact of different rate or rhythm control strategies on exercise tolerance in patients with HFpEF and AF is warranted. CLINICAL
trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00763867.
Indexed as
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.