Prediction of Mortality and Morbidity With a 6-Minute Walk Test in Patients With Left Ventricular Dysfunction

Abstract

<h3>Objective.</h3> —To study the potential usefulness of the 6-minute walk test, a self-paced submaximal exercise test, as a prognostic indicator in patients with left ventricular dysfunction. <h3>Design.</h3> —Data were collected during a prospective cohort study, the Studies of Left Ventricular Dysfunction (SOLVD) Registry Substudy. <h3>Setting.</h3> —Twenty tertiary care hospitals in the United States, Canada, and Belgium. <h3>Participants.</h3> —A stratified random sample of 898 patients from the SOLVD Registry who had either radiological evidence of congestive heart failure and/or an ejection fraction of 0.45 or less were enrolled in the substudy and underwent a detailed clinical evaluation including a 6-minute walk test. Patients were followed up for a mean of 242 days. <h3>Outcome Measures.</h3> —Mortality and hospitalization. <h3>Results.</h3> —During follow-up, 52 walk-test participants (6.2%) died and 252 (30.3%) were hospitalized. Hospitalization for congestive heart failure occurred in 78 participants (9.4%), and the combined endpoint of death or hospitalization for congestive heart failure occurred in 114 walk-test participants (13.7%). Compared with the highest performance level, patients in the lowest performance level had a significantly greater chance of dying (10.23% vs 2.99%;<i>P</i>=.01), of being hospitalized (40.91% vs 19.90%;<i>P</i>=.002), and of being hospitalized for heart failure (22.16% vs 1.99%;<i>P</i>&lt;.0001). In a logistic regression model, ejection fraction and distance walked were equally strong and independent predictors of mortality and heart failure hospitalization rates during follow-up. <h3>Conclusion.</h3> —The 6-minute walk test is a safe and simple clinical tool that strongly and independently predicts morbidity and mortality in patients with left ventricular dysfunction. (<i>JAMA</i>. 1993;270:1702-1707)