Copyright © 2001 by the European Society of Cardiology.
Six-minute walking performance in patients with moderate-to-severe heart failure; is it a useful indicator in clinical practice?
a Cardiology Division, Medical Center of Pavia, S. Maugeri Foundation, Institute of Care and Scientific Research, Pavia, Italy
c Heart Failure Unit, Medical Center of Montescano (PV), Montescano, Italy
b Department of Biomedical Engineering, Medical Center of Montescano (PV), Montescano, Italy
d Policlinico S. Matteo,>Institute of Care and Scientific Research, Cardiology Department, Pavia, Italy
revised June 6, 2000; accepted June 7, 2000
Abstract
Aims The 6-min walk test has been incorporated into studies on the efficacy of new therapies and into prognostic stratification for chronic heart failure patients. Firm conclusions on the usefulness of the test in clinical practice are still lacking. The aim of this study was to investigate (1) the correlation between walk test performance and standard indices of cardiac function and exercise capacity, and (2) the prognostic value of the walk test with respect to peak VdotO2and NYHA class.
Methods and Results Three hundred and fifteen chronic heart failure patients (age: 53±9 years, NYHA class: II (182), III (133)) underwent a functional evaluation and a 6-min walk test. Of these, 270 were followed-up for a minimum of 6 months (mean 387±177 days). Walked distance was 396±92m. There was no significant correlation between distance walked and central haemodynamic data. Functional capacity, as measured by ergometry, correlated moderately with distance walked (duration: r=0·48, peak VdotO2: r=0·59, anaerobic threshold: r=0·54; all P<0·001). During follow-up, 46 patients died from cardiovascular causes and 12 were urgently transplanted. Either of these events were considered end points of the study. Survival analysis was performed from a continuous walk test and peak VdotO2measurements or after categorization of (a) quartile segmentation, (b) cut-off points from the literature and (c) thresholds from receiver operating characteristic curves. At univariate survival analysis (Cox regression), the association of the walk test with survival was of significance (P=0·03, continuous variable), or borderline significance (0·05
P0·1, after categorization). Peak VdotO2was always significant, indepedent of the scale used (0·005P0·03). The strongest association was found for NYHA class (P<0·001), which showed the highest sensitivity and specificity for the prediction of the event (0·64 and 0·65, respectively). When walk test performance, continuous or categorized, was entered into a multivariate model with NYHA class or peak VdotO2, it lost any significant association with survival (P>0·76 in all models with NYHA class andP >0·27 in all models with peak VdotO2).
Conclusion In moderate-to-severe chronic heart failure patients, the 6-min walk test is not related to cardiac function and only moderately related to exercise capacity. Walking performance does not provide prognostic information which can complement or substitute for that provided by peak VdotO2or NYHA class. Hence the test is of limited usefulness as a decisional indicator in clinical practice.
Key Words: Heart failure, prognosis, exercise, walk test, risk factors
f1 Correspondence: Dr Cristina Opasich, Fondazione S. Maugeri, Divisione di Cardiologia, Via Ferrata 4, I-27100 Pavia, Italy.
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