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

doi:10.1002/ejhf.976

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^*

^*Corresponding author for this work

Department of Clinical Medicine

23 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 (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.

Original language	English
Journal	European Journal of Heart Failure
Volume	20
Issue number	4
Pages (from-to)	715-722
Number of pages	8
ISSN	1388-9842
DOIs	https://doi.org/10.1002/ejhf.976
Publication status	Published - 2018

Keywords

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

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Wolsk, E., Kaye, D., Borlaug, B. A., Burkhoff, D., Kitzman, D. W., Komtebedde, J., Lam, C. S. P., Ponikowski, P., Shah, S. J., & Gustafsson, F. (2018). Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction. European Journal of Heart Failure, 20(4), 715-722. https://doi.org/10.1002/ejhf.976

@article{05d1e0cd8b2441c094182a0fc09cbc4a,

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

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 (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.",

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",

year = "2018",

doi = "10.1002/ejhf.976",

language = "English",

volume = "20",

pages = "715--722",

journal = "European Journal of Heart Failure, Supplement",

issn = "1567-4215",

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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 - 2018

Y1 - 2018

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

U2 - 10.1002/ejhf.976

DO - 10.1002/ejhf.976

M3 - Journal article

C2 - 28949052

AN - SCOPUS:85030626444

SN - 1567-4215

VL - 20

SP - 715

EP - 722

JO - European Journal of Heart Failure, Supplement

JF - European Journal of Heart Failure, Supplement

IS - 4

ER -

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

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Keywords

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