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 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.
Highlights
Cardiopulmonary exercise testing (CPET) is an important tool which is used to predict prognosis in adults with heart failure [1,2,3]
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
We hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy
Summary
Cardiopulmonary exercise testing (CPET) is an important tool which is used to predict prognosis in adults with heart failure [1,2,3]. Giardini et al [6] studied ambulatory children with dilated cardiomyopathy (DCM) and demonstrated that a peak VO2 B 62% of predicted was associated with a 10 times higher risk of death and urgent transplantation than a peak VO2 [ 62%. These results are of great importance for heart failure management in children, the use of CPET has some important limitations. It is time-consuming and demanding for patients with severe heart failure. An advantage of the 6MWT is that it can be performed starting from the age of 6 years
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