title: 6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure.
abstract: OBJECTIVE
  The goal of this study was to compare the prognostic efficacy of the 6-min walk (6MW) and cardiopulmonary exercise (CPX) tests in stable outpatients with chronic heart failure (HF).
  
  
  BACKGROUND
  CPX and 6MW tests are commonly applied as prognostic gauges for systolic HF patients, but few direct comparisons have been conducted.
  
  
  METHODS
  Stable New York Heart Association (NYHA) functional class II and III systolic HF patients (ejection fraction ≤ 35%) from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were studied. 6MW distance (6MWD) and CPX indices (peak oxygen consumption [VO(2)] and ventilatory equivalents for exhaled carbon dioxide [VE/VCO(2)] slope) were compared as predictors of all-cause mortality/hospitalization and all-cause mortality over 2.5 years of mean follow-up.
  
  
  RESULTS
  A total of 2,054 HF-ACTION participants underwent both CPX and 6MW tests at baseline (median age 59 years; 71% male; 64% NYHA functional class II and 36% NYHA functional class III/IV). In unadjusted models and in models that included key clinical and demographic covariates, C-indices of 6MWD were 0.58 and 0.65 (unadjusted) and 0.62 and 0.72 (adjusted) in predicting all-cause mortality/hospitalization and all-cause mortality, respectively. C-indices for peak VO(2) were 0.61 and 0.68 (unadjusted) and 0.63 and 0.73 (adjusted). C-indices for VE/VCO(2) slope were 0.56 and 0.65 (unadjusted) and 0.61 and 0.71 (adjusted); combining peak VO(2) and VE/VCO(2) slope did not improve the C-indices. Overlapping 95% confidence intervals and modest integrated discrimination improvement values confirmed similar prognostic discrimination by 6MWD and CPX indices within adjusted models.
  
  
  CONCLUSIONS
  In systolic HF outpatients, 6MWD and CPX indices demonstrated similar utility as univariate predictors for all-cause hospitalization/mortality and all-cause mortality. However, 6MWD or CPX indices added only modest prognostic discrimination to models that included important demographic and clinical covariates.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. deforman@partners.org
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.forename: Ann M
authors.initials: AM
authors.lastname: Swank
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
authors.forename: Robert M
authors.initials: RM
authors.lastname: Clare
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: Mark E
authors.initials: ME
authors.lastname: Dunlap
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
mesh_terms: D000328:Adult; D000368:Aged; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010101:Oxygen Consumption; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D016138:Walking / Q000502:physiology*