Walk Test

IJCS

Original Article

Prognostic Value of the 6-Minute Walk Test and Clinical Characteristics of Patients With Transthyretin Amyloid Cardiomyopathy

Cristhian Espinoza Romero et al. Natalia Melo Pereira Georgina Del Cisne Jadán Luzuriaga Bruno Vaz Kerges Bueno … Suenia Carvalhal Thais Borges Barbara Reis Fábio Fernandes

Abstract

Background:

In transthyretin amyloid cardiomyopathy (ATTR-CM), the assessment of functional capacity is of great importance. A distance < 300m covered in the 6-minute walk test (6MWT) is linked to a poorer prognosis in heart failure (HF) patients. However, in ATTR-CM, this association is not well-established, particularly among its various presentations and variants.

Objectives:

To evaluate functional capacity and, the prognostic value of the 6MWT in patients with ATTR-CM and to identify their clinical characteristics according to the type of ATTR-CM.

Methods:

This was a retrospective, single-center study that included patients with a confirmed diagnosis of ATTR-CM who performed the 6MWT. Median follow-up was 19 months (8 – 29). The significance level was set at P < 0.05.

Results:

A total of 32 patients were analyzed; 59.4% had the hereditary form (ATTRh), of which 63.2% were Val142Ile. Mean left ventricular ejection fraction (LVEF) was lower in the ATTRh group when compared to the wild-type form (ATTRwt) [42 ±11 versus 52± 9 %; p = 0.029]. Median distance walked in the 6MWT was 328 m (269 – 397; IQR) in ATTRwt and 304 m (246 – 387; IQR) in ATTRh, with no difference between groups (p = 0.833). In patients with a distance <300 m in the 6MWT, survival was lower (28.8 vs 36.3 months; p = 0.041).

Conclusions:

A distance <300 m walked in the 6MWT was linked to shorter event-free survival in patients with ATTR-CM. Functional capacity of most patients was very low, and no differences were observed in the distance covered between the wild-type form and the hereditary form of ATTR.

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IJCS

Editorial

Two-Minute Walk Test After an Acute Myocardial Infarction: Feasible and Useful?

Humberto Villacorta

Acute myocardial infarction (AMI) is a common, life-threatening condition requiring prompt diagnosis and treatment.^, Patients who survive an AMI must receive the best evidence-based care to improve survival and reduce recurrent cardiovascular events. Studies have shown patients with AMI and reduced exercise capacity have a worse prognosis than those with preserved functional capacity.

Exercise capacity can be assessed using cardiopulmonary exercise testing (CPET) or, alternatively, the 6-minute walk test (6MWT). Unlike the CPET, the 6MWT is simple and does not require complex equipment or specialized technical skills. During this simple and safe test, patients are instructed to walk as far as possible along a 30-meter corridor for 6 minutes. The primary measurement is the distance walked in those 6 minutes, recorded in meters. While the 6MWT is a well-established test, it is time-consuming and can be challenging for severely impaired individuals. The 2-minute walk test (2MWT) may be an alternative for assessing functional capacity in frail or ill patients and has been evaluated in several scenarios ().^–

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IJCS

Original Article

Feasibility of the Two-Minute Walk Test in Elderly Patients After Acute Myocardial Infarction: A Cross-Sectional Study

André Luiz Lisboa Cordeiro et al. Luiz Anselmo Santos Lucas Oliveira Ana Cristina Almeida … Damaris Alves Hanna Beatriz de Melo Moraes e Silva Fernanda Francisco Souza André Raimundo França Guimarães

Abstract

Background

Pathologies involving the heart are still the main causes of death, and acute myocardial infarction (AMI) is consistently present in this index. The two-minute walk test (2MWT) is ideal for assessing the functional capacity of this patient.

Objective

To describe the feasibility of the 2MWT in older people after AMI.

Methods

This is a cross-sectional study. At hospital discharge, patients were invited to perform the 2MWT. Before starting the test, systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral oxygen saturation (SpO₂), heart rate (HR) and the Double Product (DP) were checked. After checking the vital signs, the patients were accompanied by an examiner, who was positioned laterally to ensure safety and verbally encouraged during the test; after the completion of the test, all vital signs were reassessed in two moments, at the immediate end and after 20 minutes of rest. ANOVA was used for the comparison of pre and post-test and pre and recovery. A p<0.05 was considered significant.

Results

We evaluated 51 patients, 4 (80%) males with a mean age of 67±8 years. The distance walked on the 2MWT had a mean of 157 ± 22 meters. The SBPmmHg Pre-Test 112±21 vs 131±15 Post-Test (p=0.24) and 119±22 at Recovery (p = 0.34) and HR (bpm) Pre-Test 75±15 vs 89±19 Post-Test (p=0.15) and 79±15 at Recovery (p = 0.59). After a rest, all variables analyzed followed the same pattern, returning to values close to the pre-test moment.

Conclusion

The performance of the 2MWT in the hospital environment presents good feasibility in the evaluation of submaximal capacity in elderly patients after AMI.

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IJCS

Brief Communication

Effects of Cardiac Resynchronization Therapy on a Six-minute Walk Test, Maximal Inspiratory Pressure and Peak Expiratory Flow in Patients with Heart Failure: A Longitudinal Study

Christiane Rodrigues Alves et al. Sergio S. M. C. Chermont Christiane Wiefels Reis Erivelton A. Nascimento … Mario Luiz Ribeiro Fernanda Ribeiro Evandro Tinoco Mesquita Claudio Tinoco Mesquita

Abstract

Background:

Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure.

Objective:

To evaluate the response of CRT in maximal inspiratory pressure (MIP), peak expiratory flow (PEF), and exercise tolerance as determined by the six-minute walk test (6MWT) in patients with HF.

Methods:

This study used the 6MWT and Manovacuometer to assess functional capacity in relation to activities of daily living, in which fatigue and dyspnea are common.

Results:

After six months of CRT, this study identified improvements in the 6MWT, p<0.05; MIP, p=0.01; and PEF, p=0.03.

Conclusion:

After CRT, this study showed a significant improvement in MIP, PEF, and exercise tolerance. However, further studies are warranted to demonstrate the relevance of these findings.

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IJCS

Editorial

Simplicity and Complexity of the Six-Minute Walk Test

José Antônio Caldas Teixeira

The cardiopulmonary exercise testing (CPET) is known to be the gold standard method for the assessment of functional capacity. However, the method is expensive, often not well tolerated by the patients, and may not be a good strategy to evaluate activities of daily living (ADL). Functional tests are indirect method to assess functional status or functional capacity of an individual to perform ADL and meet their metabolic demands. These tests are considered objective measures that can monitor the clinical course of several diseases as well as responses to interventional therapies.

Walking and running tests were originally developed to evaluate and estimate aerobic physical fitness of healthy individuals and correlate it with maximal aerobic power (peak VO₂). Balke, in the sixties, followed by Cooper and his 12-minute test, used to evaluate physical performance in healthy subjects, motivated, according to them, by the need of field tests for screening of large populations. These methods showed good correlation with laboratory measurements of aerobic capacity (peak VO₂ and anaerobic threshold).

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