Reliability, construct validity and determinants of 6-minute walk test performance in patients with chronic heart failure

• Published in: International journal of cardiology 2017-08, Vol.240, p.285-290
• Main Authors: Uszko-Lencer, Nicole H.M.K, Mesquita, Rafael, Janssen, Eefje, Werter, Christ, Brunner-La Rocca, Hans-Peter, Pitta, Fabio, Wouters, Emiel F.M, Spruit, Martijn A
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Chronic Disease; Exercise test; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - physiopathology; Humans; Male; Middle Aged; Reliability of results; Reproducibility of Results; Retrospective Studies; Walk Test - methods; Walk Test - standards
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.02.109

Abstract Background In-depth analyses of the measurement properties of the 6-minute walk test (6MWT) in patients with chronic heart failure (CHF) are lacking. We investigated the reliability, construct validity, and determinants of the distance covered in the 6MWT (6MWD) in CHF patients. Methods 337 patients were studied (median age 65 years, 70% male, ejection fraction 35%). Participants performed two 6MWTs on subsequent days. Demographics, anthropometrics, clinical data, ejection fraction, maximal exercise capacity, body composition, lung function, and symptoms of anxiety and depression were also assessed. Construct validity was assessed in terms of convergent, discriminant and known-groups validity. Stepwise linear regression was used. Results 6MWT was reliable (ICC = 0.90, P < 0.0001). The learning effect was 31 m (95%CI 27, 35 m). Older age (≥ 65 years), lower lung diffusing capacity (< 80% predicted) and higher NYHA class (NYHA III) were associated with a lower likelihood of a meaningful increase in the second test (OR 0.45–0.56, P < 0.05 for all). The best 6MWD had moderate-to-good correlations with peak exercise capacity ( rs = 0.54–0.69) and no-to-fair correlations with body composition, lung function, ejection fraction, and symptoms of anxiety and depression ( rs = 0.04–0.49). Patients with higher NYHA classes had lower 6MWD. 6MWD was independently associated with maximal power output during maximal exercise, estimated glomerular filtration rate and age (51.7% of the variability). Conclusion 6MWT was found to be reliable and valid in patients with mild-to-moderate CHF. Maximal exercise capacity, renal function and age were significant determinants of the best 6MWD. These findings strengthen the clinical utility of the 6MWT in CHF.