Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights

Marco Guazzi, Kenneth Dickstein, Marco Vicenzi, Ross Arena
Circulation. Heart Failure 2009, 2 (6): 549-55

BACKGROUND: The six-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) are the 2 testing modalities most broadly used for assessing functional limitation in patients with heart failure (HF). A comprehensive comparison on clinical and prognostic validity of the 2 techniques has not been performed and is the aim of the present investigation.

METHODS AND RESULTS: Two hundred fifty-three patients diagnosed with systolic (n=211) or diastolic (n=42) HF (age: 61.9+/-10.1 years; New York Heart Association Class: 2.2+/-0.78) underwent a 6MWT and a symptom-limited CPET evaluation and were prospectively followed up. During the 4-year tracking period, there were 43 cardiac-related deaths with an annual cardiac mortality rate of 8.7%. The 6MWT distance correlated with CPET-derived variables (ie, peak Vo(2), Vo(2) at anaerobic threshold, and Ve/Vco(2) slope) and was significantly reduced in proportion with lower peak Vo(2) and higher Ve/Vco(2) slope classes and presence of an exercise oscillatory breathing (EOB) pattern (P<0.01). However, no significant differences were observed in distance covered between survivors and nonsurvivors (353.2+/-95.8 m versus 338.5+/-76.4 m; P=NS). At univariate and multivariate Cox proportional analyses, the association of the 6MWT distance with survival was not significant either as a continuous or dicotomized variable (< or =300 m). Conversely, CPET-derived variables emerged as prognostic with the strongest association found for EOB (systolic HF) and Ve/Vco(2) slope (entire population with HF and patients with a 6MWT< or =300 m).

CONCLUSIONS: The 6MWT is confirmed to be a simple and reliable first-line test for quantification of exercise intolerance in patients with HF. However, there is no supportive evidence for its use as a prognostic marker in alternative to or in conjunction with CPET-derived variables.

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