Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure
den Boer, Susanna L; Flipse, Daniël H K; van der Meulen, Marijke H; Backx, Ad P C M; du Marchie Sarvaas, Gideon J; Ten Harkel, Arend D J; van Iperen-Schutte, Gabrielle; Rammeloo, Lukas A J; Tanke, Ronald B; Helbing, Willem A; Takken, Tim; Dalinghaus, Michiel
(2017) Pediatric Cardiology, volume 38, issue 3, pp. 465 - 471
(Article)
Abstract
Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the
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6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4-15.1), median time after diagnosis was 3.6 years (IQR 0.6-7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD%). For all patients, mean 6MWD% was 70 ± 21%. Median follow-up was 33 months (IQR 14-50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD% resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD% < 63% had a 2 year transplant-free survival of 73%, in contrast to a transplant-free survival of 92% in patients with a 6MWD% ≥ 63% (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.
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Keywords: 6-minute walk test, Dilated cardiomyopathy, Exercise test, Pediatrics, Prognosis, 6-minute walk test, Cardiology and Cardiovascular Medicine, Pediatrics, Perinatology, and Child Health, Multicenter Study, Journal Article
ISSN: 0172-0643
Publisher: Springer New York
Note: Funding Information: SdB was supported by a grant from “Stichting Hartedroom” [Rotterdam, The Netherlands], “Stichting Spieren voor spieren” [Amsterdam, The Netherlands] and “Zeldzame ziekten fonds” [The Hague, The Netherlands]. The funder had no influence on the study design, in the collection, the analysis and the interpretation of the data, in writing the report and in the decision to submit the paper for publication. Publisher Copyright: © 2016, The Author(s).
(Peer reviewed)