The Importance of the Double Product in the Six-Minute Walk Test to Predict Myocardial Function

Introduction. The Six-Minute Walk Test (6MWT) is a widely used test to measure the physical performance of patients to assess the effectiveness of treatment, to qualify for rehabilitation, and to evaluate its effects..Aim.This paper focuses on the assessment of the growth of a double product (DP) during the 6MWT and its diagnostic value in the assessment of patients with heart failure.Material and Methods. The paper has retrospective character. We analyzed medical records of 412 patients hospitalized for cardiac reasons, in whom a 6MWT was performed. The patients were divided into two groups: one with diagnosed heart failure and a control group.Results. The patients with diagnosed heart failure, compared to the control group, were characterized by a shorter walking distance and greater DP increase at equal walking intervals. After distinguishing the group with the preserved and decreased left ventricle ejection fraction, the value of the DP increase was still higher compared to the control group. The mean DP increase corresponding to one meter of walk was the only one that correlated negatively with the left ventricular ejection fraction.Conclusion.The assessment of the increase of the DP during the march test seems to be a better parameter reflecting the efficiency of the myocardium from the distance of the march.

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Prognostic role of results of dynamic capnography in integral assessment of parameters of respiratory system in 6-minute walk test in patients with chronic heart failure

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020283290-299 ◽

2020 ◽

Vol 28 (3) ◽

pp. 290-299

Author(s):

Kira A. Ageeva ◽

Evgenii V. Filippov

Keyword(s):

Respiratory System ◽

Prognostic Significance ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Walk Test ◽

Ventricular Ejection Fraction ◽

6Mwt Distance ◽

6 Minute Walk Test ◽

Minute Walk

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF). Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months). Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001. Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.

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P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.603 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M D M Perez Gil ◽

V Mora Llabata ◽

A Saad ◽

A Sorribes Alonso ◽

V Faga ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Amyloidosis ◽

Nyha Class ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction ◽

Apical Rotation ◽

Dynamic Torsion

Abstract BACKGROUND New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural. PURPOSE. To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA). METHODS. Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF > 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º). We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV. RESULTS There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA. However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table). CONCLUSIONS In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV. Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p < 0.001 < 0.01 0.46 0.46 < 0.01 < 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.

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Efficacy of Intramyocardial Injection of Angiogenic Cell Precursors for Ischemic Cardiomyopathy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31816755dd ◽

2008 ◽

Vol 3 (1) ◽

pp. 38-45 ◽

Cited By ~ 2

Author(s):

Kitipan V. Arom ◽

Permyos Ruengsakulrach ◽

Vibul Jotisakulratana

Keyword(s):

Quality Of Life ◽

Ischemic Cardiomyopathy ◽

Nyha Class ◽

Left Ventricular Ejection ◽

Cell Group ◽

Control Group ◽

Walk Test ◽

Six Minute Walk Test ◽

Minute Walk

Introduction The objective of this study is to determine the efficacy of intramyocardial angiogenic cell precursors (ACPs) injection in ischemic cardiomyopathy (ICM). Methods Twenty-five ICM patients (cell group) underwent intramyocardial ACPs injection. Seventeen ICM patients (control group) treated by medical means were matched with cell group. There was no statistically significant difference between cell and control groups in relation to left ventricular ejection fraction (LVEF) and comorbidities. In the cell group, mean age was 58.4 ± 13.7 years. Mean LVEF was 26.1% ± 7.4%. New York Heart Association (NYHA) class was 2.9 ± 0.6. The ACPs were derived and expanded from autologous blood. The number of cells before injection was 27.4 ± 18.8 million cells. The cells were injected into the nonviable myocardium and hypokinetic segments in the cell group. Results There was no new ventricular arrhythmia. NYHA was improved by 0.9 ± 1.0 (P < 0.001) at 229.9 ± 98.8 days. Six-minute walk test and quality of life assessed by short form-36 improved in the cell group. LVEF was improved in 72% of patients (18 of 25). LVEF improved by 6.4 ± 9.9 points % (P = 0.003) at 290.4 ± 210.3 days. The percentage of infarction area decreased 21.9 ± 17.4 points % at 159 ± 54 days postoperatively. There was no significant improvement of NYHA and LVEF in the control group. Conclusions For this efficacy study, the NYHA class, quality of life, and six-minute walk test were improved after cell transplantation. The LVEF was also significantly improved in the cell treated group.

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Level of aurathrenomedullin in chronic heart failure of ischemic genesis: associations with clinical manifestations

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2019-3-81-89 ◽

2019 ◽

Vol 18 (3) ◽

pp. 81-89

Author(s):

E. I. Myasoedova

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Clinical Manifestations ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction

Objective. To identify and evaluate the relationship between the level of proadrenomedullin and clinical and anamnestic data of patients with chronic heart failure of ischemic genesis.Materials and methods. 240 men with chronic forms of coronary heart disease (mean age 55.9 [43; 63] years) and past Q-forming myocardial infarction were examined. Of these, 110 patients had chronic heart failure and preserved left ventricular ejection fraction (group 1) and 130 patients had chronic heart failure and dilatation with a low left ventricular ejection fraction (group 2). In all patients the MR-proADM level in the blood serum was determined.Results. In the control group, the level of MR-proADM was 0.49 [0.18; 0.58] nmol /l. In the meantime, it was statistically significantly higher in the studied groups of patients than in the control group (p < 0.001 and p < 0.001, respectively). And in the group of patients with chronic heart failure and dilatation with a low left ventricular ejection fraction, it was statistically significantly higher than in the group of patients with chronic heart failure and preserved left ventricular ejection fraction (1.72 [1.56; 1.98] nmol/l and 0.89 [0.51; 1.35] nmol/l, respectively, p < 0.038). The study demonstrated the presence of statistically significant associations between the level of MR-proADM and the severity of chronic heart failure and exertional angina pectoris as well as between the presence of a constant form of atrial fibrillation and the levels of systolic and diastolic blood pressure.Conclusion. MR-proADM is a new promising marker, which will be possible to use as a diagnostic standard for assessing the effectiveness of treatment of cardiac patients.

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Comparison of left ventricular responses to the six-minute walk test, stair climbing, and maximal upright bicycle exercise in patients with congestive heart failure due to idiopathic dilated cardiomyopathy

The American Journal of Cardiology ◽

10.1016/s0002-9149(97)00285-3 ◽

1997 ◽

Vol 80 (1) ◽

pp. 65-70 ◽

Cited By ~ 19

Author(s):

Nicolas Delahaye ◽

Alain Cohen-Solal ◽

Marc Faraggi ◽

Daniel Czitrom ◽

Jean Marc Foult ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Stair Climbing ◽

Idiopathic Dilated Cardiomyopathy ◽

Walk Test ◽

Bicycle Exercise ◽

Six Minute Walk Test ◽

Minute Walk

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Chronotropic Incompetence Predicts Distance Walked in Six-Minute Walk Test in Heart Failure With Preserved Ejection Fraction

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2020.08.011 ◽

2020 ◽

Vol 26 (11) ◽

pp. 1024-1025

Author(s):

Patricia Palau ◽

Eloy Domínguez ◽

Julia Seller ◽

Clara Sastre ◽

Antoni Bayés-Genís ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Preserved Ejection Fraction ◽

Walk Test ◽

Chronotropic Incompetence ◽

Six Minute Walk Test ◽

Minute Walk

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P4541Sarcopenia in non-cachectic males with heart failure

European Heart Journal ◽

10.1093/eurheartj/ehz745.0932 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Loncar ◽

B Bozic ◽

S Von Haehling ◽

N Cvetinovic ◽

M Lainscak ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Creatinine Clearance ◽

Left Ventricular ◽

Ventricular Ejection ◽

Walking Distance ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cox Regression Analysis

Abstract Background Sarcopenia has been recently identified as a co-morbidity in patients with heart failure. Whether sarcopenia affects prognosis in non-cachectic HF patients is unknown. Purpose To assess the determinants of sarcopenia and its prognostic value in elderly males with HF. Methods A total of 73 non-diabetic, non-cachectic, male patients with HF and reduced left ventricular ejection fraction ≤40% (age: 68±7 years, left ventricular ejection fraction 29±8%) were enrolled. Sarcopenia was evaluated in accordance with revised definition of European working group on sarcopenia in older people 2 from 2018. Probable sarcopenia (or presarcopenia) was defined as low muscle strength, evaluated by lowest tertile of grip strength. A sarcopenia diagnosis was confirmed by the presence of low muscle quantity in addition to the low muscle strength, expressed as lowest tertile of appendicular skeletal muscle mass (ASM) adjusted by height square. Muscle mass was measured by dual energy X-ray absorptiometry. Patients were divided into 3 groups according to the diagnosis of the presarcopenia/sarcopenia/nonsarcopenia and were compared in respect to survival. Results 14 (19%) and 13 (18%) patients were diagnosed with presarcopenia and sarcopenia, respectively. They were older compared to nonsarcopenia patients (72±6 and 73±6 vs. 65±7, p<0.0001), with inferior physical performance expressed by 6-minute walking distance (367±73 and 360±95 vs 430±74 m, p=0.003). Patients with sarcopenia presented with lower body mass index (25±3 vs. 29±6 kg/m2, p=0.014) along with more prominent wasting of bone compartment expressed by reduced total bone mineral content (p=0.002). Creatinine clearance was significantly reduced, while NT-proBNP (log-transformed) was higher in patients with presarcopenia/sarcopenia compared to nonsarcopenia subgroup (p=0.001 and p=0.039, respectively). In multivariate logistic regression only creatinine clearance and 6-minute walking distance were independently related with sarcopenia [OR 0.936 (95% CI 0.891–0.984), p=0.009 and OR 0.992 (95% CI 0.983–1.000), p=0.050, respectively]. A total of 41 (56%) patients died within 6 years of follow-up. Kaplan-Meier survival analysis showed impaired survival in patients with presarcopenia/sarcopenia (p=0.001, Figure 1). In univariate Cox regression analysis determinants of all-cause mortality were: age, NT-proBNP (log-transformed), left ventricular ejection fraction, creatinine clearance and presence of sarcopenia (all p<0.05). In multivariate Cox regression analysis, NT-proBNP [HR 3.000 (95% CI 1.589–5.665), p=0.001], and presence of sarcopenia [HR 0.500 (95% CI 0.241–1.038), p=0.063] were independent determinants of all-cause mortality after 6 years of follow-up. Survival sarcopenia in heart failure Conclusions The rate of presarcopenia and sarcopenia was high in non-cachectic, elderly men with HF, and these patients have impaired survival compared to the patients with normal skeletal muscle status. Acknowledgement/Funding Grant of the Ministery of Science of Republic of Serbia 175033

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Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618822459 ◽

2019 ◽

Vol 8 (7) ◽

pp. 623-633 ◽

Cited By ~ 1

Author(s):

Yu Sato ◽

Akiomi Yoshihisa ◽

Masayoshi Oikawa ◽

Toshiyuki Nagai ◽

Tsutomu Yoshikawa ◽

...

Keyword(s):

Heart Failure ◽

Confidence Interval ◽

Ejection Fraction ◽

Left Ventricular ◽

Hazard Ratio ◽

Left Ventricular Ejection ◽

Control Group ◽

Preserved Ejection Fraction ◽

Primary Endpoints ◽

Patients With Heart Failure

Introduction: Hyponatremia predicts adverse prognosis in patients with heart failure in particular with reduced ejection fraction. In contrast, it has recently been reported that hyponatremia on admission is not a predictor of post-discharge mortality in patients with heart failure with preserved ejection fraction. We investigated the prognostic impact of hyponatremia at discharge in patients with heart failure with preserved ejection fraction and its clinical characteristics. Methods and results: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese patients hospitalised with heart failure with preserved ejection fraction and left ventricular ejection fraction of 50% or greater. Five hundred consecutive patients were enrolled in this analysis. We divided the patients into two groups based on their sodium serum levels at discharge: hyponatremia group (sodium <135 mEq/L, n=50, 10.0%) and control group (sodium ⩾135 mEq/L, n=450, 90.0%). This present analysis had two primary endpoints: all-cause death and all-cause death or rehospitalisation for heart failure. At discharge, the hyponatremia group had lower systolic blood pressure (110.0 mmHg vs. 114.5 mmHg, P=0.014) and higher levels of urea nitrogen (31.9 mg/dL vs. 24.2 mg/dL, P=0.032). In the Kaplan–Meier analysis, more patients in the hyponatremia group reached the primary endpoints than those in the control group (log rank <0.01, respectively). In the Cox proportional hazard analysis, hyponatremia at discharge was a predictor of the two endpoints (all-cause death, hazard ratio 2.708, 95% confidence interval 1.557–4.708, P<0.001; all-cause death or rehospitalisation for heart failure, hazard ratio 1.829, 95% confidence interval 1.203–2.780, P=0.005). Conclusions: Hyponatremia at discharge is associated with adverse prognosis in hospitalised patients with heart failure with preserved ejection fraction.

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