PMID- 23177293
OWN - NLM
STAT- MEDLINE
DCOM- 20130219
LR  - 20220410
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 60
IP  - 25
DP  - 2012 Dec 25
TI  - 6-min walk test provides prognostic utility comparable to cardiopulmonary 
      exercise testing in ambulatory outpatients with systolic heart failure.
PG  - 2653-61
LID - S0735-1097(12)04922-4 [pii]
LID - 10.1016/j.jacc.2012.08.1010 [doi]
AB  - 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 [VO(2)] and ventilatory equivalents for exhaled carbon dioxide 
      [VE/VCO(2)] 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 VO(2) were 0.61 and 0.68 (unadjusted) and 0.63 and 0.73 
      (adjusted). C-indices for VE/VCO(2) slope were 0.56 and 0.65 (unadjusted) and 
      0.61 and 0.71 (adjusted); combining peak VO(2) and VE/VCO(2) 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.
CI  - Copyright (c) 2012 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Forman, Daniel E
AU  - Forman DE
AD  - Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, 
      Massachusetts 02115, USA. deforman@partners.org
FAU - Fleg, Jerome L
AU  - Fleg JL
FAU - Kitzman, Dalane W
AU  - Kitzman DW
FAU - Brawner, Clinton A
AU  - Brawner CA
FAU - Swank, Ann M
AU  - Swank AM
FAU - McKelvie, Robert S
AU  - McKelvie RS
FAU - Clare, Robert M
AU  - Clare RM
FAU - Ellis, Stephen J
AU  - Ellis SJ
FAU - Dunlap, Mark E
AU  - Dunlap ME
FAU - Bittner, Vera
AU  - Bittner V
LA  - eng
GR  - U01 HL068973/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20121121
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2012 Dec 25;60(25):2662-3. PMID: 23177291
CIN - J Am Coll Cardiol. 2013 May 21;61(20):2112. PMID: 23524047
CIN - J Am Coll Cardiol. 2013 May 21;61(20):2113. PMID: 23524052
MH  - Adult
MH  - Aged
MH  - Exercise/*physiology
MH  - Exercise Test/*methods
MH  - Exercise Therapy/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure, Systolic/*diagnosis/mortality/therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Outpatients
MH  - Oxygen Consumption
MH  - Prognosis
MH  - Survival Rate/trends
MH  - United States/epidemiology
MH  - Walking/*physiology
PMC - PMC3766897
MID - NIHMS501876
EDAT- 2012/11/28 06:00
MHDA- 2013/02/21 06:00
PMCR- 2013/12/25
CRDT- 2012/11/27 06:00
PHST- 2012/05/01 00:00 [received]
PHST- 2012/07/30 00:00 [revised]
PHST- 2012/08/07 00:00 [accepted]
PHST- 2012/11/27 06:00 [entrez]
PHST- 2012/11/28 06:00 [pubmed]
PHST- 2013/02/21 06:00 [medline]
PHST- 2013/12/25 00:00 [pmc-release]
AID - S0735-1097(12)04922-4 [pii]
AID - 10.1016/j.jacc.2012.08.1010 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2012 Dec 25;60(25):2653-61. doi: 10.1016/j.jacc.2012.08.1010. 
      Epub 2012 Nov 21.