{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T15:23:59Z","timestamp":1761578639531,"version":"3.37.3"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T00:00:00Z","timestamp":1545350400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T00:00:00Z","timestamp":1545350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2017R1E1A1A01078382"],"award-info":[{"award-number":["2017R1E1A1A01078382"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Exercise intolerance among the clinical symptoms in patients with atrial fibrillation (AF) has usually been masked by their adjusted life style. We sought to assess the role of CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score to predict exercise intolerance in asymptomatic AF patients, and further examine whether the relationship differs by age and gender. Among the 6,275 participants of the prospective Korean registry of the Comparison study of Drugs for symptom control and complication prevention of Atrial Fibrillation (CODE-AF), 1,080 AF patients who underwent exercise treadmill testing were studied. Exercise intolerance was defined as a peak exercise capacity of 7 metabolic equivalents (METs) or less, and the patients were divided into two groups for the analysis: \u22647 METs (n\u2009=\u2009131) and &gt;7 METs (n\u2009=\u2009949). Patients with exercise intolerance had a significantly higher CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score than those without (3.1\u2009\u00b1\u20091.3 vs. 2.0\u2009\u00b1\u20091.5, p\u2009&lt;\u20090.0001). In the multivariate analysis, a higher CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score (OR 1.54, 95% CI 1.31\u20131.81, p\u2009&lt;\u20090.0001), corrected QT interval (OR 1.01, 95% CI 1.00\u20131.02, p\u2009=\u20090.026), and increased left atrial volume index (OR 1.02, 95% CI 1.01\u20131.03, p\u2009=\u20090.001) were found to be independent predictors of exercise intolerance. The impact of the CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score on exercise intolerance was significant only in male patients aged &lt;65 years (OR 3.30, 95% CI 1.76\u20136.19, p\u2009&lt;\u20090.0001). The CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score may be a feasible risk assessment tool to predict exercise intolerance, especially in young and middle-aged male patients with asymptomatic AF.<\/jats:p>","DOI":"10.1038\/s41598-018-36185-7","type":"journal-article","created":{"date-parts":[[2018,12,17]],"date-time":"2018-12-17T18:20:15Z","timestamp":1545070815000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["CHA2DS2-VASc score predicts exercise intolerance in young and middle-aged male patients with asymptomatic atrial fibrillation"],"prefix":"10.1038","volume":"8","author":[{"given":"Jeong-Eun","family":"Yi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Soo","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eue-Keun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myung-Jin","family":"Cha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae-Hoon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7931-777X","authenticated-orcid":false,"given":"Jin-Kyu","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1904-5335","authenticated-orcid":false,"given":"Jung-Myung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1361-0022","authenticated-orcid":false,"given":"Ki-Woon","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaemin","family":"Shim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae-Sun","family":"Uhm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Changsoo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-Bae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyung Wook","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9036-7225","authenticated-orcid":false,"given":"Boyoung","family":"Joung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junbeom","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2018,12,21]]},"reference":[{"key":"36185_CR1","doi-asserted-by":"publisher","first-page":"2369","DOI":"10.1093\/eurheartj\/ehq278","volume":"31","author":"AJ Camm","year":"2010","unstructured":"Camm, A. J. et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart. J. 31, 2369\u20132429 (2010).","journal-title":"Eur. Heart. J."},{"key":"36185_CR2","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.jacc.2014.03.022","volume":"64","author":"CT January","year":"2014","unstructured":"January, C. T. et al. 2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J. Am. Coll. Cardiol. 64, e1\u201376 (2014).","journal-title":"J. Am. Coll. Cardiol."},{"key":"36185_CR3","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.jacc.2006.03.051","volume":"48","author":"SN Singh","year":"2006","unstructured":"Singh, S. N. et al. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a Veterans Affairs Cooperative Studies Program Substudy. J. Am. Coll. Cardiol 48, 721\u2013730 (2006).","journal-title":"J. Am. Coll. Cardiol"},{"key":"36185_CR4","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1056\/NEJMoa011858","volume":"346","author":"J Myers","year":"2002","unstructured":"Myers, J. et al. Exercise capacity and mortality among men referred for exercise testing. N. Engl. J. Med. 346, 93\u2013801 (2002).","journal-title":"N. Engl. J. Med."},{"key":"36185_CR5","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1001\/jama.290.12.1600","volume":"290","author":"S Mora","year":"2003","unstructured":"Mora, S. et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA. 290, 1600\u20131607 (2003).","journal-title":"JAMA."},{"key":"36185_CR6","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1023\/A:1009823001707","volume":"4","author":"I Savelieva","year":"2000","unstructured":"Savelieva, I. et al. Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J. Interv. Card. Electrophysiol. 4, 369\u2013382 (2000).","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"36185_CR7","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.amjmed.2014.11.026","volume":"128","author":"G Boriani","year":"2015","unstructured":"Boriani, G. et al. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am. J. Med. 128, 509\u2013518 (2015).","journal-title":"Am. J. Med."},{"key":"36185_CR8","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1093\/eurheartj\/ehu307","volume":"36","author":"T Vanassche","year":"2015","unstructured":"Vanassche, T. et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients iin ACTIVE-A and AVERROES. Eur. Heart. J. 36, 281\u20137a (2015).","journal-title":"Eur. Heart. J."},{"key":"36185_CR9","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/eurheartj\/ehu359","volume":"36","author":"BA Steinberg","year":"2015","unstructured":"Steinberg, B. A. et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur. Heart. J. 36, 288\u2013296 (2015).","journal-title":"Eur. Heart. J."},{"key":"36185_CR10","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","volume":"128","author":"GF Fletcher","year":"2013","unstructured":"Fletcher, G. F. et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 128, 873\u2013934 (2013).","journal-title":"Circulation."},{"key":"36185_CR11","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1002\/ehf2.12098","volume":"3","author":"A Yoshihisa","year":"2016","unstructured":"Yoshihisa, A. et al. The CHA2DS2-VASc score as a predictor of high mortality in hospitalized heart failure patients. ESC. Heart Fail. 3, 261\u2013269 (2016).","journal-title":"ESC. Heart Fail."},{"key":"36185_CR12","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1016\/j.amjcard.2016.02.010","volume":"117","author":"K Orvin","year":"2016","unstructured":"Orvin, K. et al. Usefulness of the CHA2DS2-VASC Score to Predict Adverse Outcomes in Patients Having Percutaneous Coronary Intervention. Am. J. Cardiol. 117, 1433\u20131438 (2016).","journal-title":"Am. J. Cardiol."},{"key":"36185_CR13","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.ejim.2016.09.010","volume":"36","author":"Z Rozenbaum","year":"2016","unstructured":"Rozenbaum, Z. et al. CHA2DS2-VASc score and clinical outcomes of patients with acute coronary syndrome. Eur. J. Intern. Med. 36, 57\u201361 (2016).","journal-title":"Eur. J. Intern. Med."},{"key":"36185_CR14","doi-asserted-by":"publisher","first-page":"877","DOI":"10.4070\/kcj.2017.0146","volume":"47","author":"H Kim","year":"2017","unstructured":"Kim, H. et al. A Prospective Survey of Atrial Fibrillation Management for Real-world Guideline Adherence: COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Registry. Korean. Circ. J. 47, 877\u2013887 (2017).","journal-title":"Korean. Circ. J."},{"key":"36185_CR15","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1161\/CIRCULATIONAHA.105.166543","volume":"112","author":"M Lauer","year":"2005","unstructured":"Lauer, M. et al. Exercise testing in asymptomatic adults: a statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevension. Circulation. 112, 771\u2013776 (2005).","journal-title":"Circulation."},{"key":"36185_CR16","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1097\/MCA.0000000000000550","volume":"28","author":"F Haskiah","year":"2017","unstructured":"Haskiah, F. et al. CHA2DS2-VASc score and exercise capacity of patients with coronary artery disease participating in cardiac rehabilitation programs. Coron Artery Dis. 28, 697\u2013701 (2017).","journal-title":"Coron Artery Dis."},{"key":"36185_CR17","doi-asserted-by":"publisher","first-page":"2144","DOI":"10.1001\/jama.288.17.2144","volume":"288","author":"DW Kitzman","year":"2002","unstructured":"Kitzman, D. W. et al. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. Jama. 288, 2144\u20132150 (2002).","journal-title":"Jama."},{"key":"36185_CR18","doi-asserted-by":"publisher","first-page":"2217","DOI":"10.1016\/j.jacc.2016.08.048","volume":"68","author":"D Kotecha","year":"2016","unstructured":"Kotecha, D. et al. Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation: Vicious Twins. J. Am. Coll. Cardiol. 68, 2217\u20132228 (2016).","journal-title":"J. Am. Coll. Cardiol."},{"key":"36185_CR19","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1016\/j.jacc.2015.06.1314","volume":"66","author":"RA Vermond","year":"2015","unstructured":"Vermond, R. A. et al. Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality: A Community-Based Study From the Netherlands. J. Am. Coll. Cardiol 66, 1000\u20131007 (2015).","journal-title":"J. Am. Coll. Cardiol"},{"key":"36185_CR20","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1161\/CIRCHEARTFAILURE.112.972828","volume":"6","author":"JE Ho","year":"2013","unstructured":"Ho, J. E. et al. Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction. Circ. Heart Fail. 6, 279\u2013286 (2013).","journal-title":"Circ. Heart Fail."},{"key":"36185_CR21","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1161\/CIRCULATIONAHA.115.018614","volume":"133","author":"R Santhanakrishnan","year":"2016","unstructured":"Santhanakrishnan, R. et al. Atrial Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction. Circulation. 133, 484\u2013492 (2016).","journal-title":"Circulation."},{"key":"36185_CR22","doi-asserted-by":"publisher","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","volume":"62","author":"CW Yancy","year":"2013","unstructured":"Yancy, C. W. et al. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol 62, e147\u2013239 (2013).","journal-title":"J. Am. Coll. Cardiol"},{"key":"36185_CR23","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.hfc.2007.12.002","volume":"4","author":"DW Kitzman","year":"2008","unstructured":"Kitzman, D. W. et al. Exercise intolerance. Heart Fail. Clin 4, 99\u2013115 (2008).","journal-title":"Heart Fail. Clin"},{"key":"36185_CR24","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1002\/ejhf.198","volume":"17","author":"E Maor","year":"2015","unstructured":"Maor, E. et al. Exercise haemodynamics may unmask the diagnosis of diastolic dysfunction among patients with pulmonary hypertension. Eur. J. Heart Fail. 17, 151\u2013158 (2015).","journal-title":"Eur. J. Heart Fail."},{"key":"36185_CR25","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1016\/j.mayocp.2014.08.018","volume":"89","author":"N Syd\u00f3","year":"2014","unstructured":"Syd\u00f3, N. et al. Relationship between exercise heart rate and age in men vs women. Mayo Clin. Proc. 89, 1664\u20131672 (2014).","journal-title":"Mayo Clin. Proc."},{"key":"36185_CR26","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.1161\/01.CIR.0000057980.84624.95","volume":"107","author":"B Vrtovec","year":"2003","unstructured":"Vrtovec, B. et al. Prolonged QTc interval and high B-type natriuretic peptide levels together predict mortality in patients with advanced heart failure. Circulation 107, 1764\u20131769 (2003).","journal-title":"Circulation"},{"key":"36185_CR27","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1177\/2047487316633885","volume":"23","author":"Y Kato","year":"2016","unstructured":"Kato, Y. et al. The relationship beween resting heart rate and peak VO2: A comparison of atrial fibrillation and sinus rhythm. Eur. J. Prev. Cardiol. 23, 1429\u20131436 (2016).","journal-title":"Eur. J. Prev. Cardiol."},{"key":"36185_CR28","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1136\/heart.85.2.171","volume":"85","author":"T Levy","year":"2001","unstructured":"Levy, T. et al. Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study. Heart. 85, 171\u2013178 (2001).","journal-title":"Heart."},{"key":"36185_CR29","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1161\/CIRCEP.112.970749","volume":"5","author":"CE Chiang","year":"2012","unstructured":"Chiang, C. E. et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ. Arrhythm. Electrophysiol. 5, 632\u2013639 (2012).","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"36185_CR30","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1136\/hrt.78.6.564","volume":"78","author":"K Pardaens","year":"1997","unstructured":"Pardaens, K. et al. Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients. Heart. 78, 564\u2013568 (1997).","journal-title":"Heart."},{"key":"36185_CR31","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1161\/CIRCHEARTFAILURE.113.000568","volume":"7","author":"R Zakeri","year":"2014","unstructured":"Zakeri, R. et al. Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study. Circ. Heart Fail. 7, 123\u2013130 (2014).","journal-title":"Circ. Heart Fail."},{"key":"36185_CR32","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.ahj.2006.12.020","volume":"153","author":"JE Atwood","year":"2007","unstructured":"Atwood, J. E. et al. Exercise capacity in atrial fibrillation: a substudy of the Sotalol-Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T). Am. Heart. J. 153, 566\u2013572 (2007).","journal-title":"Am. Heart. J."},{"key":"36185_CR33","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1016\/j.jacc.2006.02.048","volume":"47","author":"WP Abhayaratna","year":"2006","unstructured":"Abhayaratna, W. P. et al. Left atrial size: physiologic determinants and clinical applications. J. Am. Coll. Cardiol. 47, 2357\u20132363 (2006).","journal-title":"J. Am. Coll. Cardiol."},{"key":"36185_CR34","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1093\/europace\/eux027","volume":"19","author":"D Kotecha","year":"2017","unstructured":"Kotecha, D. et al. Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review. Europace. 19, 1427\u20131438 (2017).","journal-title":"Europace."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-36185-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-36185-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-36185-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T12:16:12Z","timestamp":1671624972000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-018-36185-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,21]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["36185"],"URL":"https:\/\/doi.org\/10.1038\/s41598-018-36185-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2018,12,21]]},"assertion":[{"value":"14 June 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 November 2018","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2018","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"18039"}}