Does the 6-minute walk test predict the prognosis in patients with NYHA class II or III chronic heart failure?

doi:10.1016/S0002-8703(98)70219-4

American Heart Journal

Volume 136, Issue 3, September 1998, Pages 449-457

https://doi.org/10.1016/S0002-8703(98)70219-4 Get rights and content

Abstract

Background We prospectively evaluated the potential of the 6-minute walk test compared with Peak V̇ o₂ in predicting outcome of patients with New York Heart Association (NYHA) class II or III heart failure.

Methods and Results Patients with a history of heart failure caused by systolic dysfunction were included. The combined final outcome (death or hospitalization for heart failure) was used as the judgment criterion. One hundred twenty-one patients (age 59 ± 11 years; left ventricular ejection fraction 29.6% ± 13%) were included and followed for 1.53 ± 0.98 years. Patients were separated into two groups according to outcome: group 1 (G1, 74 patients), without events, and group 2 (G2, 47 patients), who reached the combined end point. Peak V̇ o₂ was clearly different between G1 and G2 (18.5 ± 4 vs. 13.9 ± 4 ml/kg/min, p = 0.0001) but not the distance walked (448 ± 92 vs 410 ± 126 m; p = 0.084, not significant). Survival analysis showed that unlike Peak V̇ o₂, the distance covered was barely distinguishable between the groups (p < 0.08). However, receiver operating characteristic curves revealed that the best performances for the 6-minute walk test were obtained for subjects walking ≤300 m. These patients had a worse prognosis than those walking farther (p = 0.013). In this subset of patients, there was a significant correlation between distance covered and Peak V̇ o₂ (r = 0.65, p = 0.011). Thus it appears that the more severely affected patients have a daily activity level relatively close to their maximal exercise capacity. Nevertheless, the 300 m threshold suggested by this study needs to be validated in an independent population.

Conclusions A distance walked in 6 minutes ≤300 m can predict outcome. Moreover, in these cases there is a significant correlation between the 6-minute walk test and Peak V̇ o₂ demonstrating the potential of this simple procedure as a first-line screening test for this subset of patients. (Am Heart J 1998;136:449-57.)

Section snippets

Study population

Patients of either sex and aged 18 to 76 years were enrolled if they met the following criteria: a history of heart failure caused by systolic dysfunction known for at least 3 months and the ability to perform a symptom-limited stress test and to be monitored throughout the study period (at least 1 year). Patients had to be stabilized with drug therapy for at least 1 month. No subjects with chronic bronchitis or neurologic, skeletal, or peripheral vascular disease were included. Patients with

Study population

One hundred twenty-one patients (99 men and 22 women, mean age 59 ± 11 years) met the necessary criteria and were included in the study. Their characteristics are given in Table I. All patients were in sinus rhythm and were receiving drug treatment of angiotensin-converting enzyme inhibitors, digoxin, and diuretics. The main causes of heart failure were ischemic cardiomyopathy in 47 (29%) patients and idiopathic dilated cardiomyopathy in 57 (47%) patients. Other causes (14% of cases) were

Discussion

The 6-minute walk test is a simple procedure. Its noninvasive nature, zero cost, and facility to perform make it a theoretically satisfactory method of evaluating the exercise capacity and the severity of heart failure. This procedure is, in addition, well accepted by the patients and reflects their daily activity better than more strenuous classic tests.7, 9 It is worthwhile therefore to estimate its prognostic value in common practice and to compare this with that of other well-established

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Cited by (205)

Functional outcome after cardiac rehabilitation and its association with survival in heart failure across the spectrum of ejection fraction
2023, European Journal of Internal Medicine
There is limited evidence regarding the effects of cardiac rehabilitation (CR) in patients with heart failure and preserved ejection fraction (HFpEF).
We studied 1784 patients admitted to inpatient CR. The patients were grouped into HFpEF (EF≥0.50), HF with mildly reduced EF (HFmrEF; EF 41–49), and HF with reduced EF (HFrEF; EF≤0.40). A standardized 6-min walking test was performed at admission and discharge. Measures of functional outcome were: (1) absolute increase in 6-min walking distance (6MWD) from admission to discharge >50 m and (2) increase in 6MWD to ≥300 among the patients who walked <300 m at admission.
After adjustment, the patients with HFpEF or HFmrEF were as likely as those with HFrEF to achieve an increase in 6MWD >50 m (odds ratio 0.95 [95%CI 0.71-1.24; p=0.648] and 1.04 [95%CI 0.77-1.41; p=0.769], respectively) or an increase in 6MWD to ≥300 m (odds ratio 0.79 [95%CI 0.51-1.23; p=0.299] and 0.65 [95%CI 0.38-1.12; p=0.118], respectively). The adjusted hazard ratio of 5-year mortality for patients who achieved an increase in 6MWD >50 m was 0.60 (95%CI 0.51-0.71; p<0.001) and that for patients who achieved an increase in 6MWD at discharge to ≥300 m 0.61 (95%CI 0.48-0.79; p<0.001). In each EF group, both outcomes remained independently associated with improved survival.
Our data suggest that patients with HFpEF or HFmrEF are as likely as those with HFrEF to benefit from CR in terms of functional improvement. Functional improvement was independently associated with improved long-term survival, regardless of EF.
Association of improvement in functional capacity after rehabilitation with long-term survival in heart failure
2022, International Journal of Cardiology
The prognostic value of change in six-minute walking distance (6MWD) after treatment to predict mortality in heart failure (HF) remains a controversial issue. We assessed the prognostic value of rehabilitation-induced improvement in 6MWD in predicting mortality in patients with HF.
We studied 2257 patients admitted to six inpatient rehabilitation facilities after a hospitalization for HF (N. 912) or because of worsening functional capacity and/or deteriorating clinical status (N. 1345). A six-minute walking test was performed at admission and discharge. The primary outcome was 3-year all-cause mortality after discharge from cardiac rehabilitation. We used multivariable Cox proportional hazard modeling to assess the association of increase in 6MWD with 3-year mortality, adjusting for established predictors of mortality.
6MWD significantly increased by 61 m (p < .001) from admission to discharge and 969 patients (42.9%) achieved an increase in 6MWD >50 m. After full adjustment, an increase in 6MWD >50 m was associated with a 22% decreased risk for 3-year mortality (HR 0.78 [95% CI 0.68–0.91]; p = .002). When modeled as a continuous variable, improvement in 6MWD remained independently associated with decreased risk for 3-year mortality (HR per each 50 m increase: 0.92 [95% CI 0.88–0.96]).
Rehabilitation–induced improvement in 6MWD was associated with a significantly reduced risk for 3-year mortality. Our data also suggest that an improvement in 6MWD of more than 50 m could represent a clinically meaningful endpoint of cardiac rehabilitation for patients with heart failure.
Prognostic value of 6-minute walk test and cardiopulmonary exercise test in acute heart failure (from the ESCAPE trial)
2021, American Heart Journal Plus: Cardiology Research and Practice
We aim to study the utility of 6-minute walk distance (6MWD) and cardiopulmonary exercise testing (CPET) in patients with acute systolic heart failure (HF) in predicting post-discharge outcomes.
The ESCAPE trial data was utilized to examine the prognostic role of 6MWD and CPET in predicting 6-month all-cause mortality and rehospitalization in acute HF.
The average 6MWD recorded in 271 and 292 patients on admission and discharge was 597 and 765 ft., respectively. Compared with non-survivors, survivors had significantly higher 6MWD on admission (624 vs. 463 ft., P = 0.006) and discharge (789 vs. 636 ft., P = 0.006). Admission and discharge 6MWD had an AUC of 0.629 (P = 0.0047) and 0.628 (P = 0.0093) in predicting mortality. The combination of optimal 6MWD cutoff values of >288 ft. on admission and > 320 ft. on discharge was associated with significantly lower mortality (11.1% vs. 28.3%, OR 0.316, P = 0.002). When dividing the sample into quartiles of increasing walking distance, patients in the 1st quartile had significantly higher mortality on admission (OR 3.59, 95% CI 1.396–9.282, P = 0.008) and discharge (OR 3.66, 95% CI 1.357–9.839, P = 0.01) compared with 4th quartile. P-value for the trend in mortality across quartiles of 6MWD on admission and discharge was 0.016 and 0.047, respectively. Cox proportional hazard analysis revealed that admission (HR 0.632, 95% CI 0.449–0.890, P = 0.009) and discharge 6MWD (HR 0.657, 95% CI 0.467–0.926, P = 0.016) were independent mortality determinants after adjustment for age, creatinine, sodium, systolic blood pressure and NYHA class, all on admission. CPET-derived variables did not predict either outcomes.
6MWD is an independent mortality determinant in advanced systolic HF.
Utility of 6-Minute Walk Test to Predict Response to Cardiac Resynchronization Therapy in Patients With Mild Heart Failure
2020, American Journal of Cardiology
Clinical studies of heart failure (HF) generally utilize the 6-minute walk test (6MWT) for functional capacity (FC) assessment. However, data on the impact of cardiac resynchronization therapy (CRT) on 6MWT and its role to predict long-term outcomes in mild HF patients with CRT are lacking. We studied 1,381 subjects with mild HF enrolled in Multicenter Automatic Defibrillator Implantation Trial - Cardiac Resynchronization Therapy with 6MWT data at baseline and 1 year. We assessed the effects of CRT-D on percent change in 6MWT at 1 year by left bundle branch block (LBBB) status, identified independent predictors of 6MWT at 1 year, and evaluated the association between changes in 6MWT and risk for HF or death. Treatment with CRT-D versus implantable cardiac defibrillator (ICD) was not associated with a significant improvement in 6MWT at 1-year in LBBB subjects (2.2 % vs 0.0%, p = 0.428, but it was associated with a deterioration in 6MWT in non-LBBB subjects (4.1% vs 0.0%, p = 0.308). Multivariate analysis showed that each 5% reduction in 6MWT was independently associated with a corresponding 3% increase in the risk of subsequent HF or death (p = 0.014). In conclusion, our findings suggest that 6MWT has limited utility to identify CRT response in mild HF subjects with LBBB. However, 6MWT showed a signal toward deterioration in mild HF subjects with non-LBBB, and this was predictive of subsequent increased risk of HF or death.
Predictors of Physical Capacity 6 Months After Implantation of a Full Magnetically Levitated Left Ventricular Assist Device: An Analysis From the ELEVATE Registry
2020, Journal of Cardiac Failure
In patients with a continuous-flow left ventricular assist device, preimplant predictors of poor physical performance are not well-described. We aimed to identify predictors of inability to walk more than 300 m on 6-minute walk test (6MWT) 6 months after HeartMate 3 implantation.
Using data from the European Registry of Patients Implanted With a Full Magnetically Levitated LVAD, patients with available 6MWT at 6 months after implantation were included (N = 194) and grouped according to 6MWT distance (6MWD) of >300 m (n = 150) or 6MWD of <300 m (n = 44). Patients walking <300 m were older (60 ± 10 vs 52 ± 12 years; P < .001), more often New York Heart Association functional class IV (63% vs 42%; P = .03), and more often had type 2 diabetes (43% vs 17%; P < .001) at implantation. Atrial fibrillation was seen in 57% in those with a 6MWT of <300 m vs 31% in those walking longer (P < .002). Further, hemoglobin and estimated glomerular filtration rate was lower in those walking <300 m (both P < .01). In multivariable regression analysis, independent predictors of a 6MWD of <300 m were: atrial fibrillation (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.12–8.67), older age (OR for 10-year increment, 2.81; 95% CI, 1.55–5.07), New York Heart Association functional class IV (OR, 3.37; 95% CI, 1.27–8.98), and Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2 (OR, 6.53; 95% CI, 1.92–22.19).
Six months after HeartMate 3 implantation, 77% of patients walked >300 meters in 6 minutes. Apart from age and measures of heart failure severity, atrial fibrillation at implantation is an independent predictor of low 6MWD at 6 months after implantation.
Efficacy of heart failure reversal treatment in patients with low ejection fraction
2018, Journal of Ayurveda and Integrative Medicine
Heart failure reversal therapy (HFRT) is designed to enhance cardiorespiratory fitness of chronic heart failure (CHF) patients.
The present study was designed to evaluate efficacy of HFRT that uses herbal procedure (panchakarma) and allied therapies, in CHF patients with low ejection fraction.
This efficacy study was conducted in CHF patients (aged: 25–65 years, ejection fraction (EF) 10–30%) wherein HFRT (60–75 min) consisting of snehana (external oleation), swedana (passive heat therapy), hrudaydhara (concoction dripping treatment) and basti (enema) was administered twice daily for 7 days. During this therapy and next 30 days, patients followed the study dinarcharya and were prescribed ARJ kadha in addition to their conventional treatment. The primary endpoint of this study was evaluation of maximum aerobic capacity uptake (MAC) as assessed by 6 min walk distance (6MWD) using Cahalins equation from baseline, at the end of 7 day treatment, follow-up after 30 days and 90 days. EF was assessed by 2D Echo at baseline and after 30 days of follow-up.
Fifty-two CHF patients with 10–30% EF (mean [SD] age: 58.8 [10.8], 85% men) were enrolled in the study. There was a 100% compliance to study therapy. A significant improvement was observed in MAC levels (7.11%, p = 0.029), at the end of 7 day therapy as compared to baseline. This improvement was maintained at two follow-up visits. Moreover ejection fraction was observed to be increased by 6.38%, p = 0.012 as compared to baseline at day 7 of the therapy.
This 90 day follow up study highlights the benefit of HFRT, as a part of maintenance treatment for CHF patients with reduced ejection fraction.

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^☆: From the Cardiology Department, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre.

^☆☆: Reprint requests: Gerald Roul, MD, Cardiology Department, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France.

^★: 4/1/89198

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Does the 6-minute walk test predict the prognosis in patients with NYHA class II or III chronic heart failure?☆,☆☆,★

Abstract

Section snippets

Study population

Study population

Discussion

Am J Cardiol

Chest

J Pediatr

J Am Coll Cardiol

Chest

Correlates of major complications or death in patients admitted to the hospital with congestive heart failure

Arch Intern Med

Exercise peak VO2 in chronic heart failure: is it still of value?

Eur Heart J

Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure

Circulation

Prediction of mortality and morbidity with 6-minute walk test in patients with left ventricular dysfunction

JAMA

Six minute walking test for assessing exercise capacity in chronic heart failure

Br Med J

Nuclear cardiology

The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure

Can Med Assoc J

Exercise peak VO₂ in chronic heart failure: is it still of value?