Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction

Emil Wolsk, David Kaye, Barry A Borlaug, Daniel Burkhoff, Dalane W. Kitzman, Jan Komtebedde, Carolyn S.P. Lam, Piotr Ponikowski, Sanjiv J. Shah, Finn Gustafsson

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Aims: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, and is associated with cardiovascular outcomes. However, as the association between 6MWT and haemodynamic parameters during rest and exercise in HFpEF patients is unknown, we sought to elucidate this relationship. Methods and results: Overall, 64 patients enrolled in the REDUCE LAP-HF trial completed a 6MWT at baseline. Univariate and multivariable linear regression models were used to assess the associations between 6MWT and measured or derived haemodynamic variables at baseline, during light/moderate exercise (20W), and at peak supine exercise. The average 6MWT distance was 318±106m. At rest, in a multivariable model, only pulmonary capillary wedge pressure (PCWP) was significantly associated with 6MWT [coefficient: -5.4, 95% confidence interval (CI) -10.4, -0.5, P=0.033]. During light/moderate exercise, mean pulmonary artery pressure was associated with 6MWT in a multivariable model (coefficient: -3.5, 95% CI -6.8, -0.3, P=0.033). During peak exercise, central venous pressure, cardiac index (CI), and PCWP/CI correlated with 6MWT; however, workload corrected PCWP was the only variable independently associated with 6MWT (coefficient: -0.8, 95% CI -1.3, -0.4, P<0.001). The variance in 6MWT was modestly explained by measured or derived haemodynamic variables at rest or at any stage of exercise (r2=7-17%). Conclusion: Workload corrected PCWP correlated best with 6MWT performance in HFpEF patients. Baseline haemodynamic variables were modestly correlated with 6MWT, suggesting that 6MWT performance in HFpEF patients may be significantly influenced by extra-cardiac factors.

Original languageEnglish (US)
JournalEuropean Journal of Heart Failure
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart Failure
Hemodynamics
Exercise
Pulmonary Wedge Pressure
Confidence Intervals
Workload
Linear Models
Light
Central Venous Pressure
Walk Test
Pulmonary Artery
Pressure

Keywords

  • Exercise
  • Haemodynamics
  • Heart failure with preserved ejection fraction
  • REDUCE LAP-HF
  • Six-minute walk test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction. / Wolsk, Emil; Kaye, David; Borlaug, Barry A; Burkhoff, Daniel; Kitzman, Dalane W.; Komtebedde, Jan; Lam, Carolyn S.P.; Ponikowski, Piotr; Shah, Sanjiv J.; Gustafsson, Finn.

In: European Journal of Heart Failure, 2017.

Research output: Contribution to journalArticle

Wolsk, Emil ; Kaye, David ; Borlaug, Barry A ; Burkhoff, Daniel ; Kitzman, Dalane W. ; Komtebedde, Jan ; Lam, Carolyn S.P. ; Ponikowski, Piotr ; Shah, Sanjiv J. ; Gustafsson, Finn. / Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction. In: European Journal of Heart Failure. 2017.
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abstract = "Aims: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, and is associated with cardiovascular outcomes. However, as the association between 6MWT and haemodynamic parameters during rest and exercise in HFpEF patients is unknown, we sought to elucidate this relationship. Methods and results: Overall, 64 patients enrolled in the REDUCE LAP-HF trial completed a 6MWT at baseline. Univariate and multivariable linear regression models were used to assess the associations between 6MWT and measured or derived haemodynamic variables at baseline, during light/moderate exercise (20W), and at peak supine exercise. The average 6MWT distance was 318±106m. At rest, in a multivariable model, only pulmonary capillary wedge pressure (PCWP) was significantly associated with 6MWT [coefficient: -5.4, 95{\%} confidence interval (CI) -10.4, -0.5, P=0.033]. During light/moderate exercise, mean pulmonary artery pressure was associated with 6MWT in a multivariable model (coefficient: -3.5, 95{\%} CI -6.8, -0.3, P=0.033). During peak exercise, central venous pressure, cardiac index (CI), and PCWP/CI correlated with 6MWT; however, workload corrected PCWP was the only variable independently associated with 6MWT (coefficient: -0.8, 95{\%} CI -1.3, -0.4, P<0.001). The variance in 6MWT was modestly explained by measured or derived haemodynamic variables at rest or at any stage of exercise (r2=7-17{\%}). Conclusion: Workload corrected PCWP correlated best with 6MWT performance in HFpEF patients. Baseline haemodynamic variables were modestly correlated with 6MWT, suggesting that 6MWT performance in HFpEF patients may be significantly influenced by extra-cardiac factors.",
keywords = "Exercise, Haemodynamics, Heart failure with preserved ejection fraction, REDUCE LAP-HF, Six-minute walk test",
author = "Emil Wolsk and David Kaye and Borlaug, {Barry A} and Daniel Burkhoff and Kitzman, {Dalane W.} and Jan Komtebedde and Lam, {Carolyn S.P.} and Piotr Ponikowski and Shah, {Sanjiv J.} and Finn Gustafsson",
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T1 - Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction

AU - Wolsk, Emil

AU - Kaye, David

AU - Borlaug, Barry A

AU - Burkhoff, Daniel

AU - Kitzman, Dalane W.

AU - Komtebedde, Jan

AU - Lam, Carolyn S.P.

AU - Ponikowski, Piotr

AU - Shah, Sanjiv J.

AU - Gustafsson, Finn

PY - 2017

Y1 - 2017

N2 - Aims: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, and is associated with cardiovascular outcomes. However, as the association between 6MWT and haemodynamic parameters during rest and exercise in HFpEF patients is unknown, we sought to elucidate this relationship. Methods and results: Overall, 64 patients enrolled in the REDUCE LAP-HF trial completed a 6MWT at baseline. Univariate and multivariable linear regression models were used to assess the associations between 6MWT and measured or derived haemodynamic variables at baseline, during light/moderate exercise (20W), and at peak supine exercise. The average 6MWT distance was 318±106m. At rest, in a multivariable model, only pulmonary capillary wedge pressure (PCWP) was significantly associated with 6MWT [coefficient: -5.4, 95% confidence interval (CI) -10.4, -0.5, P=0.033]. During light/moderate exercise, mean pulmonary artery pressure was associated with 6MWT in a multivariable model (coefficient: -3.5, 95% CI -6.8, -0.3, P=0.033). During peak exercise, central venous pressure, cardiac index (CI), and PCWP/CI correlated with 6MWT; however, workload corrected PCWP was the only variable independently associated with 6MWT (coefficient: -0.8, 95% CI -1.3, -0.4, P<0.001). The variance in 6MWT was modestly explained by measured or derived haemodynamic variables at rest or at any stage of exercise (r2=7-17%). Conclusion: Workload corrected PCWP correlated best with 6MWT performance in HFpEF patients. Baseline haemodynamic variables were modestly correlated with 6MWT, suggesting that 6MWT performance in HFpEF patients may be significantly influenced by extra-cardiac factors.

AB - Aims: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, and is associated with cardiovascular outcomes. However, as the association between 6MWT and haemodynamic parameters during rest and exercise in HFpEF patients is unknown, we sought to elucidate this relationship. Methods and results: Overall, 64 patients enrolled in the REDUCE LAP-HF trial completed a 6MWT at baseline. Univariate and multivariable linear regression models were used to assess the associations between 6MWT and measured or derived haemodynamic variables at baseline, during light/moderate exercise (20W), and at peak supine exercise. The average 6MWT distance was 318±106m. At rest, in a multivariable model, only pulmonary capillary wedge pressure (PCWP) was significantly associated with 6MWT [coefficient: -5.4, 95% confidence interval (CI) -10.4, -0.5, P=0.033]. During light/moderate exercise, mean pulmonary artery pressure was associated with 6MWT in a multivariable model (coefficient: -3.5, 95% CI -6.8, -0.3, P=0.033). During peak exercise, central venous pressure, cardiac index (CI), and PCWP/CI correlated with 6MWT; however, workload corrected PCWP was the only variable independently associated with 6MWT (coefficient: -0.8, 95% CI -1.3, -0.4, P<0.001). The variance in 6MWT was modestly explained by measured or derived haemodynamic variables at rest or at any stage of exercise (r2=7-17%). Conclusion: Workload corrected PCWP correlated best with 6MWT performance in HFpEF patients. Baseline haemodynamic variables were modestly correlated with 6MWT, suggesting that 6MWT performance in HFpEF patients may be significantly influenced by extra-cardiac factors.

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KW - Haemodynamics

KW - Heart failure with preserved ejection fraction

KW - REDUCE LAP-HF

KW - Six-minute walk test

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