Abstract 13603: Utility of the 6-minute Walk Test in Coronary Artery Disease Screening Before Kidney Transplant

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xingxing Cheng ◽  
Daniel J Watford ◽  
Hiroyuki Arashi ◽  
Jane C Tan ◽  
William F Fearon
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Kidney Transplant ◽  
Cardiac Death ◽  
Walk Test ◽  
Non Invasive ◽  
Cardiac Evaluation ◽  
Artery Disease ◽  
6 Minute Walk Test ◽  
Minute Walk

Introduction: Coronary artery disease (CAD) screening is a cornerstone of kidney transplant (KTx) evaluation, but existing approaches result in excess testing and low intervention rate. Hypothesis: We hypothesize that aerobic performance, based on a simple office test (the 6-minute walk test, 6MWT), may help risk stratify KTx candidates. Methods: We performed 6MWT in waitlisted patients who were nearing KTx. Results were used for frailty counselling and not for cardiac evaluation. CAD screening was done according to our center protocol: invasive angiogram for patients with long-standing diabetes mellitus (DM) and non-invasive testing for other patients with risk factors and at the evaluating transplant nephrologist’s discretion. We used subdistribution Cox regression and time-dependent receiver operator curve to evaluate time to CAD event (revascularization, myocardial infarction, waitlist removal for CAD, or cardiac death), treating waitlist removal for non-CAD and non-cardiac death as competing events. Results: Of the 360 patients, 200 and 161 patients had 6MWT results <400 meters and ≥400 meters (~4 metabolic equivalents), respectively. Patients with lower 6MWT results were older (59±10 vs 50±12 years) and more likely to be female (54% vs 34%), have DM (61% vs 33%) or known atherosclerotic disease (44% vs 22%), and have had prior cardiac evaluation (72% vs 61%). They were also more likely to exhibit cardiac symptom during 6MWT (36% vs 6%) and more likely to be censored due to waitlist removal for non-CAD reasons (follow-up 391±337 vs 541±277 days). 6MWT was not associated with CAD event (subdistribution hazard ratio 1.00 [0.90-1.10], 1-year area under the curve [AUC] 0.54). 196 patients had invasive (52%) or non-invasive (48%) CAD testing within 6 months of 6MWT: 6MWT did not predict the CAD test result (odds ratio 0.96 [0.81-1.14], AUC 0.54). Of the 94 patients who had concurrent non-invasive CAD testing, the 1-year AUC of 6MWT, symptom (at rest or during 6MWT), AST guidelines, or non-invasive testing for CAD event were 0.64, 0.52, 0.46 and 0.66 respectively. Conclusions: The 6MWT did not perform better in risk stratification for CAD events compared to a symptom- or risk factor-based approach.

scholarly journals 6-minute walking test in patients after cabg - assessment of exercise capacity

2015 ◽  
Vol 29 (2) ◽  
pp. 19-24 ◽  
Author(s):  
Joanna Wojtkowska ◽  
Izabela Wojtkowska ◽  
Jadwiga Wolszakiewicz
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Tolerance ◽  
Disease Risk ◽  
Walk Test ◽  
6Mwt Distance ◽  
Artery Disease ◽  
6 Minute Walk Test ◽  
Minute Walk

Abstract Introduction: The 6-minute walk test is a well established diagnostic tool in clinical cardiology to determine exercise tolerance, prognostic measure, control and modify the implemented treatment. Aim: Assess exercise tolerance in patients with coronary artery disease after surgical coronary artery bypass grafting using 6-minute walk test in correlation with selected concomitant risk factors for coronary artery disease. Material and methods: Analysis of medical records of 100 randomly selected patients, diagnosed by coronary angiography and coronary heart disease, scheduled for CABG. Patients were evaluated using exercise tolerance as measured by 6MWT before and 12 months after CABG. The results were correlated with the selected risk factors. Results: The study group showed improvement in 6MWT distance of 43.17 m (± 104.41) at 12-months after CABG. In order to analyze which risk factors influenced the observed changes of the 6MWT distance, the obtained results were correlated with factors such as the age of patients, sex, hypertension and smoking. There was no effect of these parameters on shortening or lengthening the distance. Conclusions: 1. From selected coronary artery disease risk factors only hypertension adversely affected the 6MWT distance before CABG. 3. The CABG operation caused significant improvement of exercise tolerance in patients with worse baseline exercise tolerance.

scholarly journals Methodological Issues of Assessment of Six-minute Walk Test in Patients with Coronary Artery Disease

2021 ◽  
Vol 20 (3) ◽  
pp. 37-44
Author(s):  
Tatiana V. Mikhailovskaya ◽  
Olga A. Nazarova ◽  
Yuriy V. Dovgalyuk ◽  
Yulia V. Chistyakova ◽  
Irina E. Mishina
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Tolerance ◽  
Walk Test ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Six Minute Walk Test ◽  
6Mwt Distance ◽  
Artery Disease ◽  
Minute Walk

The six-minute walk test (6MWT) is an easily performed and well-studied method for assessing exercise tolerance. Despite its availability, there are no standardized approaches to the evaluation of test results in patients with coronary artery disease (CAD). The current review summarizes the evidence and the practical issues of the 6MWT data interpretation in CAD patients. It is recommended by researches to follow current recommendations and protocols of 6MWT in order to achieve high accuracy and reproducibility of the test. The value of the 6MWT distance depends on gender, age, anthropometric and echocardiography parameters. Multiple tests on the same patient cannot be recommended due to the possible development of the “learning effect”. The prognostic value of the 6MWT results was recently established in patients with various diseases. The value of the 6MWT distance ≤ 300 meters in patients with heart failure with a reduced ejection fraction was associated with a significant increase in the risk of death and cardiovascular events; stable results of the 6MWT within one year were associated with a higher survival rate of patients. The concept of the minimally clinically significant difference (MCSD) in the distance of the 6MWT during cardiac rehabilitation of patients was presented. According to the recent data, the MCSD of the 6MWT distance in patients after acute coronary syndrome was 25 meters. The data of our research, the main methods and examples of calculating changes in the 6MWT distance are presented in the article. The results obtained indicate that a comprehensive analysis and simultaneous use of several methods of the 6MWT distance assessment improve the accuracy of rehabilitation results evaluation. Thus, the 6MWT is an affordable way to assess exercise tolerance. It may provide reliable information about changes in the functional capacity of CAD patients in everyday clinical practice.

Reproducibility, validity and responsiveness of the 200-metre fast walk test in patients undergoing cardiac rehabilitation

2011 ◽  
Vol 26 (8) ◽  
pp. 733-740 ◽  
Author(s):  
V Gremeaux ◽  
A Hannequin ◽  
D Laroche ◽  
G Deley ◽  
J Duclay ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Test ◽  
Maximal Exercise ◽  
Test Time ◽  
Walk Test ◽  
Maximal Exercise Test ◽  
Sf 36 ◽  
Artery Disease ◽  
Minute Walk

Objective: To investigate the reliability, validity and responsiveness of the 200-metre fast walk test in patients with coronary artery disease engaged in a cardiac rehabilitation programme. Design: Descriptive study. Setting: Tertiary care hospital. Subjects: Thirty stable patients with coronary artery disease (51.9 ± 8.7 years), referred to the cardiac rehabilitation department after an acute coronary syndrome. Intervention: Not applicable. Main measures: Six-minute walk test distance, time to perform the 200-m fast walk test, peak power output of the graded maximal exercise test, before and after the programme; SF-36 quality of life questionnaire at baseline. Walk tests were performed twice at baseline to assess reliability. Results: The 200-m fast walk test was highly reliable (ICC = 0.97). It was significantly correlated with the graded maximal exercise test peak power and the 6-minute walk test at baseline ( r = −0.417; P < 0.05; and r = −0.566; P < 0.01, respectively) and after the training programme ( r = −0.460, P < 0.05; and r = −0.926; P < 0.01, respectively). At baseline, there was a strong correlation between the 200-m fast walk test time and the physical component score of the SF-36 ( r = −0.77; P < 0.01), but not between the 200-m fast walk test time and the SF-36 mental component score. Mean 200-m fast walk test time was significantly different between the patients performing ≤90 W ( n = 11) or ≥100 W ( n = 19) at the baseline graded maximal exercise test (121.7 ± 13.6 vs. 115.5 ± 10.1 seconds; P < 0.05). The responsiveness was strong with a standardized response mean at 1.11. Conclusion: The 200-m fast walk test is a reliable, valid and responsive high-intensity walk test in patients with coronary artery disease after an acute coronary syndrome. It can thus give additional information to that given by the 6-minute walk test and the graded maximal exercise test.

scholarly journals The body weight-walking distance product as a superior parameter in determining the VO2 on-kinetics in coronary artery disease

2019 ◽  
Author(s):  
Isadora S. Rocco ◽  
Walter J. Gomes ◽  
Hayanne O. Pauletti ◽  
Marcela Viceconte ◽  
Bruna C. Matos-Garcia ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
The Body ◽  
Walking Distance ◽  
Walk Test ◽  
Artery Disease ◽  
Test Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Abstract Background The 6-minute walk test distance is frequently used to assess functional capacity of cardiac disease population. Nevertheless, anthropometric differences can confound or misestimate performance, which highlights the need for new parameters. This study aims to investigate the potential of the body weight-walking distance product (D.W), compared to 6-minute walk test distance, to predict exercise capacity measured by VO 2 on-kinetics in coronary artery disease (CAD) patients.Methods Cross-section study in a tertiary-care reference institution. Forty-six participants with multiarterial CAD with and without left ventricular dysfunction underwent a 6-minute walk test with simultaneous use of mobile telemetric cardiopulmonary monitoring to evaluate oxygen uptake (VO 2 ) on-kinetics and other cardiorespiratory responses.Results Perceived effort Borg for lower limb fatigue was only correlated with the D.W (p=0.007). The percent-predicted and actual distance were only modestly to moderately correlated with VO 2 on-kinetics (p<0.05). All the associations of VO 2 on-kinetics parameters were improved by showing a stronger correlation to the D.W (p<0.0001), which also had a larger effect size to identify differences between coronary disease patients compared to distance ( d =1.32 vs d =0.84).Conclusion The D.W demonstrates potential as a measure superior to the distance in determining VO 2 on-kinetics in participants with CAD with and without left ventricular dysfunction.

scholarly journals Evaluation of the effect of taurine on the course of coronary artery disease associated with diabetes of the 2nd type, in patients undergoing coronary revascularization

2018 ◽  
pp. 94-99
Author(s):  
A. V. Svarovskaya ◽  
A. A. Garganeeva
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Resistance Index ◽  
Group 2 ◽  
Artery Disease ◽  
6 Minute Walk Test ◽  
Minute Walk

The aimwas to study the effect of taurine in the complex therapy of patients with coronary artery disease associated with type 2 diabetes mellitus (DM2) who underwent coronary revascularization.Material and methods. Examined 53 patients with coronary artery disease associated with type 2 diabetes, after undergoing endovascular revascularization of the myocardium, which were distributed in 2 groups. The 1st group included 30 patients who received, in addition to basic therapy, taurine at a dose of 500 mg 2 times a day. In group 2 (n = 23) – patients who received only basic therapy of ischemic heart disease and diabetes. Body mass index, waist and hip volume, as well as physical tolerance by means of Bicycle ergometry and 6-minute walk test were evaluated. Indicators of carbohydrate and lipid metabolism wer e determined, insulin resistance index was calculated.Results. At the end of 16-week therapy, physical tolerance according toVEM in group 1 increased by 29.67% (p<0.01), in group 2-by 9.14% (p>0.05). The distance during the 6-minute walk test was significantly increased in both groups: by 34.37% and by 25.80%, respectively. Patients of group 1 had a significant decrease in BMI by 11.52%, postprandial glucose level by 19.38% (p = 0.018), insulin by 18.90%, glyca ted hemoglobin (HbA1c) by 13.21%, insulin resistance index by 17.65%, triglyceride by 14.14% (p<0.05), low density lipoprotein cholesterol by 16.05% (p<0.01).), aspartate aminotransferases and alanine aminotransferases – by 27.75% and 16.52%, respectively.Conclusion. Sup plement taurine standard therapy of coronary heart disease associated with type 2 diabetes mellitus, in patients who have undergone endovascular myocardial revascularization, has a positive effect on the performance of carbohydrate and lipid metabolism, reduces body weight, improves physical performance. 

Stress-induced Myocardial Ischaemia – Perfusion Contrast Echocardiography to Evaluate Presence and Severity of Coronary Artery Disease

2011 ◽  
Vol 7 (3) ◽  
pp. 172
Author(s):  
Benoy Nalin Shah ◽  
Roxy Senior ◽  
◽  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Contrast Echocardiography ◽  
Evidence Base ◽  
Suspected Coronary Artery Disease ◽  
Ultrasound Contrast Agents ◽  
Prognostic Information ◽  
Non Invasive ◽  
Artery Disease

The development of stable transpulmonary ultrasound contrast agents (UCAs) has allowed the echocardiographic assessment of myocardial perfusion, a technique known as myocardial contrast echocardiography (MCE). MCE exploits the ultrasonic properties of UCAs, which consist of acoustically active gas-filled microspheres. These are intravascular agents that have a rheology similar to red blood cells and thus allow analysis of myocardial blood flow both at rest and after stress. The combined assessment of wall motion and myocardial perfusion provides significant diagnostic and prognostic information during stress echocardiography. Functional imaging tests, such as myocardial perfusion scintigraphy and stress cardiac magnetic resonance imaging, are also used for non-invasive assessment of coronary disease. The principal advantages of MCE are that it does not expose the patient to ionising radiation or radioactive pharmaceuticals, is not contraindicated in patients with an implanted metallic device or who suffer from claustrophobia and it can be performed at the bedside. The purpose of this article is to outline the physiological principles underpinning ischaemia testing with MCE before proceeding to review the evidence base for MCE in patients with known or suspected coronary artery disease.

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