Prognostic Significance and Determinants of the 6-Min Walk Test in Patients With Heart Failure and Preserved Ejection Fraction

Abstract Objectives This study sought to define the prognostic significance and clinical determinants of the 6-min walk distance (6-MWD) in affected patients. Background Symptoms of exertional fatigue and dyspnea, as well as a reduced exercise tolerance, are cardinal features of pulmonary hypertensi...

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Published in:JACC. Heart failure 2015-06, Vol.3 (6), p.459-466
Main Authors: Zotter-Tufaro, Caroline, MSc, Mascherbauer, Julia, MD, Duca, Franz, MD, Koell, Benedikt, Aschauer, Stefan, MD, Kammerlander, Andreas A., MD, Panzenboeck, Adelheid, MSc, Sadushi-Kolici, Roela, MD, Bangert, Christine, MD, Laimer, Daniela, PhD, Ristl, Robin, PhD, Lang, Irene M., MD, Bonderman, Diana, MD
Format: Article
Language:English
Subjects:
Aged
Cardiac Catheterization
Cardiovascular
Exercise Test
extracellular matrix
Female
Heart Failure - diagnosis
Heart Failure - pathology
Heart Failure - physiopathology
Heart Ventricles - pathology
Humans
Male
Prognosis
Prospective Studies
pulmonary circulation
Stroke Volume - physiology
Ventricular Dysfunction, Left - physiopathology
Walking - physiology
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Summary:Abstract Objectives This study sought to define the prognostic significance and clinical determinants of the 6-min walk distance (6-MWD) in affected patients. Background Symptoms of exertional fatigue and dyspnea, as well as a reduced exercise tolerance, are cardinal features of pulmonary hypertension associated with heart failure and preserved ejection fraction (PH-HFpEF). Mechanisms limiting exercise capacity in this specific entity remain incompletely understood. Methods Consecutive patients with PH-HFpEF, as confirmed by right heart catheter, were enrolled in our prospective registry. Hospitalization for HF and/or death for cardiac reasons were defined as primary outcome. Multiple regression models were constructed to establish determinants of the 6-MWD. For quantification of left ventricular (LV) extracellular matrix (ECM), myocardial biopsies were taken from 18 patients. Results Between December 2010 and July 2013, 142 PH-HFpEF patients were included in the study. After a mean follow-up of 14.0 ± 10.0 months, 43 patients (30.3%) reached the combined endpoint. The 6-MWD was found to be an independent predictor of outcome and was influenced by a variety of clinical, echocardiographic, hemodynamic, laboratory, and pulmonary parameters. There was a significant inverse correlation between the 6-MWD and the extent of ECM in the LV myocardium. Conclusions Impaired exercise capacity in PH-HFpEF patients is explained by cardiac and noncardiac factors. The 6-MWD predicts outcome and may be a useful endpoint in clinical trials.
ISSN:2213-1779
2213-1787
DOI:10.1016/j.jchf.2015.01.010