Elsevier

International Journal of Cardiology

Volume 76, Issues 2–3, November–December 2000, Pages 101-105
International Journal of Cardiology

Shuttle versus six-minute walk test in the prediction of outcome in chronic heart failure

https://doi.org/10.1016/S0167-5273(00)00393-4Get rights and content

Abstract

We prospectively analysed the potential usefulness of a symptom-limited walk test, the shuttle walk test (SWT), in the prediction of major cardiac events in 46 consecutive patients with chronic heart failure (NYHA class II–IV, ejection fraction <0.40) and compared it with that of a time-limited walk test, the six-minute walk test (6-MT). After a mean follow-up of 17 months (range, 8–28 months), 15 of 46 patients (33%) experienced a major cardiac event, defined as a cardiac death, urgent transplantation, or hospital admission for continuous inotropic or mechanical support. Distance walked in the SWT was shown to be a predictor of outcome at one year of follow-up (P=0.03), but distance ambulated in the 6-MT was not (P=0.07). In multivariate analysis, percentage of age–gender predicted peak oxygen uptake was the best predictor of major cardiac events. When patients were divided into tertiles according to performance in both walk tests, there was an overall difference in event-free survival at 12 months among SWT tertiles (P=0.004), but not among 6-MT tertiles (P=0.09). A low performance in the SWT (distance ambulated <450 m) allowed identification of a subgroup of patients with a high risk for major cardiac events at short-term. We conclude that, in patients with chronic heart failure, distance ambulated in the SWT predicts event-free survival at one year better than that in the 6-MT.

Introduction

Although measurement of peak oxygen uptake provides a valuable assessment of functional capacity and prognosis in patients with chronic heart failure, the procedure for such a technique is complex and expensive. More simple exercise tests have been developed in this way. The distance walked in the six-minute walk test (6-MT) shows a moderate correlation with peak oxygen uptake [1], and some authors have suggested that a low performance in the 6-MT may predict ulterior cardiac events in these patients [1], [2], [3].

A shuttle walk test (SWT) has been developed to assess functional limitation in patients with obstructive chronic bronchitis [4]. It is a symptom-limited test, with a progressive structure. We [5] and others [6] have applied it to patients with chronic heart failure, finding that it is a feasible, simple and safe test. Moreover, we found that the distance walked in the SWT was an independent predictor of peak oxygen uptake in these patients, but distance in the 6-MT was not [5], [7].

We investigated if this recently developed test offers potential benefits with respect to the 6-MT in the prediction of prognosis in patients with chronic heart failure.

Section snippets

Methods

Forty-six patients (nine women), with a mean age of 53.0 (S.D., 10.5) years, NYHA class II–IV heart failure symptoms, and systolic dysfunction (ejection fraction <0.40; mean, 0.23; S.D., 0.08) were prospectively studied in our Heart Failure Clinic. Nineteen patients (41%) were in NYHA functional class II, 21 patients (46%) in NYHA class III, and six (13%) were in class IV. Usual clinical, echocardiographic, radionuclide–angiographic and rest hemodynamic variables were obtained for each patient,

Results

Clinical data and results from Doppler echocardiography, radionuclide–angiography, cardiopulmonary exercise testing, walk tests (SWT and 6-MT) and haemodynamics are displayed in Table 1. There were no relevant complications related to performance of any walk test. Univariate relationships to peak oxygen uptake were 0.83 for SWT distance (P<0.001), and 0.69 for 6-MT distance (P<0.001). Of note, all patients who walked >450 m in the SWT had a peak oxygen consumption >14 ml/kg/min.

After a mean

Discussion

In our study, walking a distance under 450 m in the SWT was associated with a significantly higher probability of experiencing a major cardiac event within 12 months than walking a longer distance. We did not find adequate risk stratification at 12 months for distance walked in the 6-MT. This result is consistent with that reported by Cahalin et al. [1], who found that 6-MT distance predicted event-free survival at 6 months, but not at one year. Bittner et al. [2] found distance ambulated in

Acknowledgements

Supported by a grant from the Public Health Service of Andalucı́a, Spain (Consejerı́a de Salud de la Junta de Andalucı́a).

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Presented in part at the 71st Scientific Sessions of the American Heart Association, Dallas, TX, USA, November 8–11, 1998.

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