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
N1 - Funding Information:
The REDUCE HF-LAP study was financed by Corvia Medical, Inc. Conflict of interest: E.W. has none to declare. D.K. receives unrestricted research grants and is an unpaid members of the Corvia Medical Scientific Advisory Group. B.A.B. receives research funding from the NHLBI (RO1 HL128526 and U10 HL110262), Mast Therapeutics, Medtronic, GlaxoSmithKline, and Teva; has consulted and served on advisory boards for Actelion, Amgen, AstraZeneca, Merck and MyoKardia. D.B.: Hemodynamic Core
Funding Information:
Laboratory for Corvia Medical; Founder PVLoops, LLC. D.W.K. received consulting fees from Corvia Medical, Medtronic, Bayer, Merck, Relypsa, and Abbvie, and research funding from Novartis. J.K. is employee of Corvia Medical, Inc. C.S.P.L. is supported by a Clinician Scientist Award from the National Medical Research Council of Singapore; has received research support from Boston Scientific, Bayer, Thermofisher, Medtronic, and Vifor Pharma; and has consulted for Bayer, Novartis, Takeda, Merck, Astra Zeneca, Janssen Research & Development, LLC, Menarini, Boehringer Ingel-heim and Abbott Diagnostics; has been compensated as a member of the CEC for REDUCE LAP-HF. P.P. receives unrestricted research grants and is an unpaid member of the Corvia Medical Scientific Advisory Group. S.J.S. received research funding from Actelion, AstraZeneca, Corvia, and Novarits, and consulting fees from Actelion, AstraZeneca, Bayer, Ironwood, Merck, Novartis, and Sanofi. F.G. receives unrestricted research grants and is an unpaid member of the Corvia Medical Scientific Advisory Group.
Publisher Copyright:
© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology
PY - 2018/4
Y1 - 2018/4
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 (20 W), and at peak supine exercise. The average 6MWT distance was 318 ± 106 m. 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 (20 W), and at peak supine exercise. The average 6MWT distance was 318 ± 106 m. 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
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U2 - 10.1002/ejhf.976
DO - 10.1002/ejhf.976
M3 - Article
C2 - 28949052
AN - SCOPUS:85030626444
VL - 20
SP - 715
EP - 722
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 4
ER -