Six-Minute Walk Test and Cardiopulmonary Exercise Testing in Patients With Chronic Heart Failure: A Comparative Analysis on Clinical and Prognostic Insights

Abstract

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 (n=211) or diastolic (n=42) HF (age: 61.9�10.1 years; New York Heart Association Class: 2.2�0.78) 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 V o 2 , V o 2 at anaerobic threshold, and V e /V co 2 slope) and was significantly reduced in proportion with lower peak V o 2 and higher V e /V co 2 slope classes and presence of an exercise oscillatory breathing (EOB) pattern ( P <0.01). However, no significant differences were observed in distance covered between survivors and nonsurvivors (353.2�95.8 m versus 338.5�76.4 m; P =NS). 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 (≤300 m). Conversely, CPET-derived variables emerged as prognostic with the strongest association found for EOB (systolic HF) and V e /V co 2 slope (entire population with HF and patients with a 6MWT≤300 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.