Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: A comparison with cardiopulmonary exercise testing

Lawrence P. Cahalin, Ross Arena, Valentina Labate, Francesco Bandera, Carl J. Lavie, Marco Guazzi

Research output: Contribution to journalArticle

Abstract

AimsHeart rate recovery (HRR) appears to be a robust prognostic marker in heart failure (HF). When using the 6 min walk test (6MWT) in HF, distance ambulated is generally the reference prognostic variable. We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated.Methods and resultsA 6MWT and cardiopulmonary exercise testing (CPX) were randomly performed in 258 HF patients [216 HF with reduced EF (HFrEF) and 42 HF preserved EF (HFpEF)], after which HRR was measured. HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination. Patients were assessed for major cardiac events during a mean follow-up period of 22.8 ± 22.1 months. There were 50 major cardiac events during the tracking period. Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant (P <0.001) predictor of adverse events. Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival (χ2 61.1 and 53.8, respectively; P <0.001), with LVEF (residual χ2 6.1, P <0.05) adding significant prognostic value to the 6MWT model and ventilatory efficiency (the VE/VCO2 slope) (residual χ2 6.6, P <0. 05) adding significant prognostic value to the CPX model.ConclusionsHRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise. If confirmed in subsequent studies, 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients. All rights reserved.

Original languageEnglish
Pages (from-to)519-527
Number of pages9
JournalEuropean Journal of Heart Failure
Volume15
Issue number5
DOIs
Publication statusPublished - May 2013

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Heart Failure
Heart Rate
Exercise
Regression Analysis
Walk Test
Survival

Keywords

  • 6 Min walk test
  • Cardiopulmonary exercise test
  • Heart failure
  • Heart rate recovery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{9b624d627c00431bb657086dd788955d,
title = "Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: A comparison with cardiopulmonary exercise testing",
abstract = "AimsHeart rate recovery (HRR) appears to be a robust prognostic marker in heart failure (HF). When using the 6 min walk test (6MWT) in HF, distance ambulated is generally the reference prognostic variable. We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated.Methods and resultsA 6MWT and cardiopulmonary exercise testing (CPX) were randomly performed in 258 HF patients [216 HF with reduced EF (HFrEF) and 42 HF preserved EF (HFpEF)], after which HRR was measured. HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination. Patients were assessed for major cardiac events during a mean follow-up period of 22.8 ± 22.1 months. There were 50 major cardiac events during the tracking period. Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant (P <0.001) predictor of adverse events. Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival (χ2 61.1 and 53.8, respectively; P <0.001), with LVEF (residual χ2 6.1, P <0.05) adding significant prognostic value to the 6MWT model and ventilatory efficiency (the VE/VCO2 slope) (residual χ2 6.6, P <0. 05) adding significant prognostic value to the CPX model.ConclusionsHRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise. If confirmed in subsequent studies, 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients. All rights reserved.",
keywords = "6 Min walk test, Cardiopulmonary exercise test, Heart failure, Heart rate recovery",
author = "Cahalin, {Lawrence P.} and Ross Arena and Valentina Labate and Francesco Bandera and Lavie, {Carl J.} and Marco Guazzi",
year = "2013",
month = "5",
doi = "10.1093/eurjhf/hfs216",
language = "English",
volume = "15",
pages = "519--527",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "John Wiley & Sons, Ltd",
number = "5",

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TY - JOUR

T1 - Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction

T2 - A comparison with cardiopulmonary exercise testing

AU - Cahalin, Lawrence P.

AU - Arena, Ross

AU - Labate, Valentina

AU - Bandera, Francesco

AU - Lavie, Carl J.

AU - Guazzi, Marco

PY - 2013/5

Y1 - 2013/5

N2 - AimsHeart rate recovery (HRR) appears to be a robust prognostic marker in heart failure (HF). When using the 6 min walk test (6MWT) in HF, distance ambulated is generally the reference prognostic variable. We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated.Methods and resultsA 6MWT and cardiopulmonary exercise testing (CPX) were randomly performed in 258 HF patients [216 HF with reduced EF (HFrEF) and 42 HF preserved EF (HFpEF)], after which HRR was measured. HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination. Patients were assessed for major cardiac events during a mean follow-up period of 22.8 ± 22.1 months. There were 50 major cardiac events during the tracking period. Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant (P <0.001) predictor of adverse events. Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival (χ2 61.1 and 53.8, respectively; P <0.001), with LVEF (residual χ2 6.1, P <0.05) adding significant prognostic value to the 6MWT model and ventilatory efficiency (the VE/VCO2 slope) (residual χ2 6.6, P <0. 05) adding significant prognostic value to the CPX model.ConclusionsHRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise. If confirmed in subsequent studies, 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients. All rights reserved.

AB - AimsHeart rate recovery (HRR) appears to be a robust prognostic marker in heart failure (HF). When using the 6 min walk test (6MWT) in HF, distance ambulated is generally the reference prognostic variable. We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated.Methods and resultsA 6MWT and cardiopulmonary exercise testing (CPX) were randomly performed in 258 HF patients [216 HF with reduced EF (HFrEF) and 42 HF preserved EF (HFpEF)], after which HRR was measured. HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination. Patients were assessed for major cardiac events during a mean follow-up period of 22.8 ± 22.1 months. There were 50 major cardiac events during the tracking period. Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant (P <0.001) predictor of adverse events. Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival (χ2 61.1 and 53.8, respectively; P <0.001), with LVEF (residual χ2 6.1, P <0.05) adding significant prognostic value to the 6MWT model and ventilatory efficiency (the VE/VCO2 slope) (residual χ2 6.6, P <0. 05) adding significant prognostic value to the CPX model.ConclusionsHRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise. If confirmed in subsequent studies, 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients. All rights reserved.

KW - 6 Min walk test

KW - Cardiopulmonary exercise test

KW - Heart failure

KW - Heart rate recovery

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U2 - 10.1093/eurjhf/hfs216

DO - 10.1093/eurjhf/hfs216

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