Insuficiência cardíaca: comparação entre o teste de caminhada de seis minutos e o teste cardiopulmonar (original) (raw)
Related papers
2009
Background-The six-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) are the 2 testing modalities most broadly used for assessing functional limitation in patients with heart failure (HF). A comprehensive comparison on clinical and prognostic validity of the 2 techniques has not been performed and is the aim of the present investigation. Methods and Results-Two hundred fifty-three patients diagnosed with systolic (nϭ211) or diastolic (nϭ42) HF (age: 61.9Ϯ10.1 years; New York Heart Association Class: 2.2Ϯ0.78) underwent a 6MWT and a symptom-limited CPET evaluation and were prospectively followed up. During the 4-year tracking period, there were 43 cardiac-related deaths with an annual cardiac mortality rate of 8.7%. The 6MWT distance correlated with CPET-derived variables (ie, peak VO 2 , VO 2 at anaerobic threshold, and VE/VCO 2 slope) and was significantly reduced in proportion with lower peak VO 2 and higher VE/VCO 2 slope classes and presence of an exercise oscillatory breathing (EOB) pattern (PϽ0.01). However, no significant differences were observed in distance covered between survivors and nonsurvivors (353.2Ϯ95.8 m versus 338.5Ϯ76.4 m; PϭNS). At univariate and multivariate Cox proportional analyses, the association of the 6MWT distance with survival was not significant either as a continuous or dicotomized variable (Յ300 m). Conversely, CPET-derived variables emerged as prognostic with the strongest association found for EOB (systolic HF) and VE/VCO 2 slope (entire population with HF and patients with a 6MWTՅ300 m). Conclusions-The 6MWT is confirmed to be a simple and reliable first-line test for quantification of exercise intolerance in patients with HF. However, there is no supportive evidence for its use as a prognostic marker in alternative to or in conjunction with CPET-derived variables. (Circ Heart Fail. 2009;2:549-555.)
Different determinants of exercise capacity in HFpEF compared to HFrEF
Cardiovascular Ultrasound, 2017
Background: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic determinants of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF. Methods: In 111 HF patients (mean age 63 ± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m). Results: Group I were older (p = 0.008), had higher prevalence of diabetes (p = 0.027), higher baseline heart rate (p = 0. 004), larger left atrium-LA (p = 0.001), longer LV filling time-FT (p = 0.019), shorter isovolumic relaxation time (p = 0.037), shorter pulmonary artery acceleration time-PA acceleration time (p = 0.006), lower left atrial lateral wall myocardial velocity (a') (p = 0.018) and lower septal systolic myocardial velocity (s') (p = 0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p = 0.007), higher baseline heart rate (p = 0.005), higher NT-ProBNP (p = 0.001), larger LA (p = 0.004), lower septal s', e', a' waves, and septal mitral annular plane systolic excursion (MAPSE), shorter PA acceleration time (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e', and shorter LVFT (p = 0.001 for all), lower lateral e' (p = 0.009), s' (p = 0.006), right ventricular e' and LA emptying fraction (p = 0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p = 0.012], and diabetes [0.274 (0.084-0.898), p = 0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012-1.137), p = 0.018] and LA diameter [3.685 (1.348-10.071), p = 0.011], but in HFpEF, lateral s' [0.295 (0.099-0.882), p = 0.029], and hemoglobin level [0.497 (0.248-0.998), p = 0.049] independently predicted poor 6-MWT performance. Conclusions: In HF patients determinants of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main determinants.
SN Comprehensive Clinical Medicine
The aim of this study was to evaluate the effect of concurrent aerobic-resistance training (CART) on aerobic power, heart function, and biomarker in patients with chronic heart failure (CHF). A total of 76 HF with reduced ejection fraction (HFrEF) (EF < 40%) participated in the two groups, intervention group (IG, N = 38) and control group(CG, N = 38) that IG performed an 8-week CART program (3 times a week for 45-60 min) and walking (another 4 days a week for 30 min). 6MWT, heart rate variability, echocardiography parameters, NT-proBNP, and Galectin-3(Gal-3) were evaluated before and after the program. The
Reproducibility of the self-controlled six-minute walking test in heart failure patients
Clinics, 2008
INTRODUCTION: The six-minute walk test (6WT) has been proposed to be a submaximal test, but could actually demand a high level of exercise intensity from the patient, expressed by a respiratory quotient >1.0, following the guideline recommendations. Standardizing the 6WT using the Borg scale was proposed to make sure that all patients undergo a submaximal walking test. PURPOSE: To test the reproducibility of the six-minute treadmill cardiopulmonary walk test (6CWT) using the Borg scale and to make sure that all patients undergo a submaximal test. METHODS: Twenty-three male heart failure patients (50±9 years) were included; these patients had both ischemic (5) and non-ischemic (18) heart failure with a left ventricle ejection fraction of 23±7%, were diagnosed as functional class NYHA II-III and were undergoing optimized drug therapy. Patients were guided to walk at a pace between "relatively easy and slightly tiring" (11 and 13 on Borg scale). The 6CWT using the Borg scale was performed two times on a treadmill with zero inclination and patient control of speed with an interval of 24 hours. During the sixth minute, we analyzed ventilation (VE, L/min), respiratory quotient, Oxygen consumption (VO2, ml/kg/min), VE/VCO2 slope, heart rate (HR, bpm), systolic blood pressure (SBP, mmHg), diastolic (DBP, mmHg) blood pressure and distance. RESULTS: The intraclass correlation coefficients at the sixth minute were: HR (ri=0.96, p<0.0001), VE (ri=0.84, p<0.0001), SBP (ri=0.72, p=0.001), distance (ri=0.88, p<0.0001), VO2 (ri=0.92, p<0.0001), SlopeVE/VCO2 (ri=0.86, p<0.0001) and RQ<1 (ri=0.6, p=0.004). CONCLUSION: Using the 6CWT with the Borg scale was reproducible, and it seems to be an appropriate method to evaluate the functional capacity of heart failure patients while making sure that they undergo a submaximal walking test.
A questionnaire-based assessment of daily physical activity in heart failure
European Journal of Heart Failure, 2004
Type and dose of daily energy expenditure (DEE) play a major role in modulations of health status and an increased knowledge of these dimensions of physical activity in congestive heart failure (CHF) patients would be valuable for clinical and epidemiological aims. We propose a new self-administered DEE questionnaire adapted to CHF patients and tested its validity. One hundred and five stable CHF participants, NYHA class I-IV, LVEF = 33.2F6.1% performed an incremental symptom-limited VO 2 (peak) test and filled in the questionnaire for DEE calculation. Reproducibility (n = 24), sensitivity (n = 21) of the questionnaire and inter-observer variability (n = 105) were tested. Intensity levels were identified from DEE and their relationships to VO 2 (peak), ventilatory and anthropometric characteristics were assessed by simple and multiple regression models. Reproducibility and sensitivity were high (r = 0.98 and 0.88, respectively, P < 0.0001) and inter-observer error reached 1.37%. DEE was highly correlated to physical activity energy expenditure (r = 0.96, P < 0.0001). Relationships between DEE, VO 2 (peak), V E /VO 2 and anthropometric characteristics were significant. An activity level above 3 MET was the best intensity criteria related to VO 2 (peak) (r = 0.62, P < 0.0001) and DEE (r = 0.80, P < 0.0001). The questionnaire seems reproducible, sensible and valid for DEE estimation. VO 2 (peak) appears related to DEE and especially to activities above 3 MET in CHF.
Journal of Cardiac Failure, 2008
Background: The 6-minute walk test (6MWT) is a widely used measure of functional capacity in patients with chronic heart failure (CHF). Norm-referenced equations that predict the 6-minute walk distance (6MWD) according to age, height, weight, and gender have been proposed for healthy patients. We explored whether these equations apply to CHF patients. Methods and Results: The sample consisted of 213 patients newly admitted to specialized CHF clinics in Montreal, Canada. Percent predicted value (PPV) for 6MWD was calculated using norm-referenced equations. We explored correlations between different measures: PPV, 6MWD, Minnesota Living with Heart Failure Quality of Life score (MLHF-QOL). We compared severity among different age, gender, and BMI (body mass index) subgroups and assessed consistency using different measures of severity. Mean age was 65.5 years and 77.5% were men. Compared with the 6MWD, PPV had a slightly better correlation with MLHF-QOL score (À0.26 versus À0.20), and slightly more predictive power in linear regressions (adjusted r 2 5 6.5% versus 4.2%). When PPV was used to differentiate severity between different age, gender, and BMI subgroups, it consistently led to similar conclusions as the MLHF-QOL score, unlike 6MWD. Conclusion: The 6MWD in meters may give misleading results when used as an indicator of severity of CHF condition to compare groups with different sex, age, and BMI distributions. It may be necessary to standardize it using norm-referenced equations. (J Cardiac Fail 2008;14:75e81)
International Journal of Cardiology, 2005
Aims: The extent of exercise intolerance in patients with chronic heart failure (CHF) is dependent on and representative of the severity of heart failure. However, few primary care physicians have direct access to facilities for formal exercise testing. We have therefore explored whether information readily obtainable in the community can reliably predict the functional capacity of patients. Methods and results: Ninety-six subjects with a wide range of cardiac function (10 healthy controls and 86 CHF patients with NYHA classes I-IV, LVEF 36.9F15.2%) were recruited into the study and had resting plasma N-BNP and cardiopulmonary exercise testing to measure peak oxygen consumption (VO 2 ). Significantly higher N-BNP levels were found in the CHF group (299.3 [704.8] fmol/ml, median [IQR]) compared with the healthy control group (7.2 [51.2] fmol/ml), pb0.0001. There were significant correlations between peak VO 2 and N-BNP levels (R=0.64, Pb0.001), peak VO 2 and NYHA class (R=0.76, P=0.001), but no significant correlation was seen between peak VO 2 and LVEF (R=0.0788, P=0.33). Multivariate analysis identified plasma N-BNP ( Pb0.0001) and NYHA class ( Pb0.0001) as significant independent predictors of peak VO 2 . Logistic modelling with NYHA class and log N-BNP to predict peak VO 2 b20 ml/kg/min showed that the area under the curve of receiver-operating-characteristic (ROC) curve was 0.906 (95% CI 0.844-0.968). A nomogram based on the data has been constructed to allow clinicians to estimate the likelihood of peak VO 2 to be b20 ml/kg/min for given values of plasma N-BNP and NYHA class. Conclusions: By combining information from a simple objective blood test (N-BNP) and a simple scoring of functional status (NYHA), a clinician can deduce the aerobic exercise capacity and indirectly the extent of cardiac dysfunction of patients with CHF.
Predictors of exercise capacity in heart failure
International Cardiovascular Forum Journal, 2015
Background and Aim: Compromised exercise capacity is a major symptom in patients with heart failure (HF) and reduced left ventricular (LV) ejection fraction (eF). six-minute walk test (6-MWt) is popular for the objective assessment of exercise capacity in these patients but is largely confined to major heart centres. the aim of this study was to prospectively examine functional parameters that predict 6-MWt in patients with HF and reduced LVeF. Methods: In 111 HF patients (mean age 60±12 years, 56% male), a 6-MWt and an echo-Doppler study were performed in the same day. In addition to conventional ventricular function measurements, global LV dyssynchrony was indirectly assessed by total isovolumic time-t-IVt [in s/min; calculated as: 60-(total ejection time-total filling time)], and tei index (t-IVt/ejection time). Also, LV and right ventricular function were assessed by mitral and tricuspid annular plane systolic excursion (MAPse and tAPse, respectively). Based on the 6-MWt distance, patients were divided into 2 groups: group I: ≤300m and group II: >300m. Results: the 6-MWt distance correlated with t-IVt and tei index (r=-0.37, p<0.001, for both), lateral and septal e' velocities (r=0.41, p<0.001, and r=0.46, p<0.001, respectively), e/e' ratio (r=-0.37, p<0.001) and tAPse (r=0.45, p<0.001), but not with the other clinical or echo parameters. group I patients had longer t-IVt, lower e/e'ratio, tAPse and lateral e' (p<0.001 for all) compared with group II. In multivariate analysis, tAPse [0.076 (0.017-0.335), p=0.001], e/e' [1.165 (1.017-1.334), p=0.027], t-IVt [1.178 (1.014-1.370), p=0.033] independently predicted poor 6-MWt performance (<300m). sensitivity and specificity for tAPse ≤1.9 cm were 66% and 77%, (AuC 0.78, p<0.001); e/e' ≥10.7 were 66% and 62% (AuC 0.67, p=0.002) and t-IVt ≥13 s/min were 64% and 60% (AuC 0.68, p=0.002) in predicting poor 6-MWt. Combined tAPse and e/e' had a sensitivity of 68% but specificity of 92% in predicting 6-MWt. Respective values for combined tAPse and t-IVt were 71% and 85%. Conclusion: In patients with HF, the limited exercise capacity assessed by 6-MWt, is multifactorial being related both to the severity of right ventricular systolic dysfunction as well as to raised LV filling pressures and global dyssynchrony.