Clinical Research
Heart Failure
6-Min Walk Test Provides Prognostic Utility Comparable to Cardiopulmonary Exercise Testing in Ambulatory Outpatients With Systolic Heart Failure

https://doi.org/10.1016/j.jacc.2012.08.1010Get rights and content
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Objectives

The goal of this study was to compare the prognostic efficacy of the 6-min walk (6MW) and cardiopulmonary exercise (CPX) tests in stable outpatients with chronic heart failure (HF).

Background

CPX and 6MW tests are commonly applied as prognostic gauges for systolic HF patients, but few direct comparisons have been conducted.

Methods

Stable New York Heart Association (NYHA) functional class II and III systolic HF patients (ejection fraction ≤35%) from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were studied. 6MW distance (6MWD) and CPX indices (peak oxygen consumption [VO2] and ventilatory equivalents for exhaled carbon dioxide [VE/VCO2] slope) were compared as predictors of all-cause mortality/hospitalization and all-cause mortality over 2.5 years of mean follow-up.

Results

A total of 2,054 HF-ACTION participants underwent both CPX and 6MW tests at baseline (median age 59 years; 71% male; 64% NYHA functional class II and 36% NYHA functional class III/IV). In unadjusted models and in models that included key clinical and demographic covariates, C-indices of 6MWD were 0.58 and 0.65 (unadjusted) and 0.62 and 0.72 (adjusted) in predicting all-cause mortality/hospitalization and all-cause mortality, respectively. C-indices for peak VO2 were 0.61 and 0.68 (unadjusted) and 0.63 and 0.73 (adjusted). C-indices for VE/VCO2 slope were 0.56 and 0.65 (unadjusted) and 0.61 and 0.71 (adjusted); combining peak VO2 and VE/VCO2 slope did not improve the C-indices. Overlapping 95% confidence intervals and modest integrated discrimination improvement values confirmed similar prognostic discrimination by 6MWD and CPX indices within adjusted models.

Conclusions

In systolic HF outpatients, 6MWD and CPX indices demonstrated similar utility as univariate predictors for all-cause hospitalization/mortality and all-cause mortality. However, 6MWD or CPX indices added only modest prognostic discrimination to models that included important demographic and clinical covariates.

Key Words

cardiopulmonary exercise testing
heart failure
prognosis
walking test

Abbreviations and Acronyms

6MW
6-minute walk
6MWD
6-minute walk distance
BMI
body mass index
CI
confidence interval
CPX
cardiopulmonary exercise
ECG
electrocardiogram
HF
heart failure
HR
hazard ratio
IDI
integrated discrimination improvement
LVEF
left ventricular ejection fraction
NYHA
New York Heart Association
VE/VCO2
ventilatory equivalents for exhaled carbon dioxide
VO2
oxygen consumption

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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.