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 language | English (US) |
|---|---|
| Journal | European Journal of Heart Failure |
| DOIs | |
| State | Accepted/In press - 2017 |
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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 journal › Article
}
TY - JOUR
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.
KW - Exercise
KW - Haemodynamics
KW - Heart failure with preserved ejection fraction
KW - REDUCE LAP-HF
KW - Six-minute walk test
UR - http://www.scopus.com/inward/record.url?scp=85030626444&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030626444&partnerID=8YFLogxK
U2 - 10.1002/ejhf.976
DO - 10.1002/ejhf.976
M3 - Article
C2 - 28949052
AN - SCOPUS:85030626444
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
ER -