Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice
Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice
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DOI：
10.1016/j.jacc.2006.02.061
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发表时间：
2006-07-04
影响因子：
24
通讯作者：
Scrutinio, Domenico
中科院分区：
文献类型：
--
作者：
Passantino, Andrea;Lagioia, Rocco;Scrutinio, Domenico
本研究的目的是探讨慢性心力衰竭（CHF）患者6分钟步行距离变化的预后价值。背景6分钟步行试验（6 MWT）的最强适应症是测量CHF患者对治疗干预的反应。治疗干预后步行距离的增加是否转化为临床结局的改善在很大程度上是unknowwon.METHODS我们研究了476例CHF患者左心室收缩功能障碍谁被称为我们的机构调整心力衰竭治疗，因为持续或恶化的症状。调整治疗涉及四类药物：血管紧张素转换酶抑制剂或血管紧张素ii受体阻滞剂，β受体阻滞剂，袢利尿剂和醛固酮拮抗剂。在基线和出院时进行标准化的6 MWT。结果15.2 +/- 8天后，步行距离从326 +/- 107增加到408 +/- 109（+25%; p = 0.001）。在平均23.9个月的随访中，94例患者死亡，12例患者接受心脏移植。在一组变量中，纽约心脏协会功能分级（p = 0.02）、血清肌酐浓度（p = 0.01）、左心室射血分数（p = 0.002）、基线行走距离（p = 0.0002）和行走距离变化（p = 0.002）是生存率的显著独立预测因素。当患者被分为两个亚组，根据中位值的距离走在基线时，步行距离的增加与生存率显着相关，只有在亚组的患者谁走在basel.CONCLUSIONS < 340，我们的数据表明，重复6 MWT药物干预后提供独立的预后信息，CHF患者的运动能力更妥协。
OBJECTIVES The purpose of this study was to investigate the prognostic value of change in distance walked in 6 min in chronic heart failure (CHF).BACKGROUND The strongest indication for the 6-min walking test (6MWT) is for measuring the response to therapeutic interventions in patients with CHF. Whether the increase in distance walked after a therapeutic intervention translates into improved clinical outcome is largely unknwon.METHODS We studied 476 CHF patients with left ventricular systolic dysfunction who were referred to our institution for adjustment of heart failure therapy because of persisting or worsening symptoms. Adjustment of therapy involved four classes of drugs: angiotensin-converting enzyme inhibitors or angiotensin ii receptor blockers, beta-blockers, loop diuretics, and aldosterone antagonists. A standardized 6MWT was performed at baseline and at discharge.RESULTS After 15.2 +/- 8 days, the distance walked increased from 326 +/- 107 in to 408 +/- 109 in (+25%; p = 0.001). During a mean follow-up of 23.9 months, 94 patients died and 12 patients underwent cardiac transplantation. Among a set of variables, New York Heart Association functional class (p = 0.02), serum creatinine concentration (p = 0.01), left ventricular ejection fraction (p = 0.002), distance walked at baseline (p = 0.0002), and change in distance walked (p = 0.002) were significant independent predictors of survival. When the patients were divided into two subgroups according to the median value of the distance walked at baseline, the increase in walking distance was significantly associated with survival only in the subgroup of patients who walked < 340 in at baseline.CONCLUSIONS Our data indicate that repeating a 6MWT after drug intervention provides independent prognostic information in CHF patients with more compromised exercise capacity.