Incremental Shuttle Walk Test Distance Research Articles

What are the determinants of change in walking fitness in patients with a history of depression following cardiac rehabilitation?

This study aims to investigate the demographic, clinical and service level factors determining change in walking fitness in cardiac rehabilitation (CR) patients with a history of depression following the CR programme. National Audit of Cardiac Rehabilitation (NACR) clinical data were used to identify 1476 patients with a history of depression who had their pre and post incremental shuttle walk test (ISWT) recorded between 1st Jan 2016 and 31st Jan 2020. A multiple linear regression was conducted to examine the determinants of change in walking fitness (m) following CR. Mean age was 61 (SD 10.45) and mean ISWT distance at baseline and outcome were 352.06m (SD 169.48) and 463.43m (SD 197.65), respectively. Multivariate analysis revealed that change in walking distance reduced by 1.6m for each year increase in age at baseline (P < 0.001). Females and unemployed patients had less improvement in walking fitness (23.1m and 21.5m, respectively). Having a body mass index >30 was associated with lower improvement (24.2m, p < 0.001), while physically active patients had 14.6m higher change. Higher baseline ISWT quintiles were associated with less improvement, and increased waiting time to start CR was associated with reduced change in walking fitness following CR. Older age, female gender, unemployment, higher baseline BMI, longer waiting time, and lower physical activity were associated with reduced walking fitness improvement in patients with a history of depression. Targeted intervention and prompt access to CR can optimize outcomes.

Using reference equations to standardise incremental shuttle walk test performance in children and young people with chronic conditions and facilitate the evaluation of exercise capacity and disease severity

AimsThe aim was to evaluate whether standardised exercise performance during the incremental shuttle walk test (ISWT) can be used to assess disease severity in children and young people (CYP) with...

Assessment of exercise capacity using field walking tests in patients after the Fontan procedure: A case–control study

BackgroundDespite the frequent use of the 6-minute walk test (6MWT), exercise capacity has not been assessed with the incremental shuttle walk test (ISWT) in patients who have undergone the Fontan procedure. It is unclear whether these tests cause clinically relevant cardiorespiratory responses in these patients. ObjectivesWe aimed to assess cardiorespiratory responses to the 6MWT and ISWT in Fontan patients, compare the responses with those in the controls, and examine the agreement between the two field tests. MethodsSubmaximal exercise capacity was assessed using the 6MWT, maximal exercise capacity using the ISWT, quadriceps isometric muscle strength with a hand dynamometer, and body composition using a bioelectrical impedance device. ResultsTwenty-one Fontan patients (16.42±6.63 years, 5F/16M) and 21 controls (16.57±4.30 years, 7F/14M) were included. While body composition was similar between the groups (p>0.05), quadriceps isometric muscle strength and 6MWT and ISWT distance were lower in the Fontan patients than in the controls (p<0.05). In both the 6MWT and ISWT, pre- and post-test heart rate (HR), oxygen saturation (SpO2), dyspnea, and leg fatigue differed significantly between the Fontan patients and the controls (p<0.05). In addition, the ISWT resulted in a more significant change in HR, SpO2, and leg fatigue than the 6MWT in the Fontan patients (p<0.05). Bland–Altman plots for the 6MWT vs. the ISWT indicated agreement between the two tests. ConclusionThere were remarkable changes in HR, SpO2, dyspnea, and leg fatigue in both tests. With similar safety to the 6MWT but with more caution applied for adverse events, the ISWT can also be performed as a field test to evaluate exercise capacity and identify more pronounced exercise-induced responses (especially oxygen desaturation) in Fontan patients.

Home-based cardiac rehabilitation and physical activity in people with heart failure: a secondary analysis of the REACH-HF randomised controlled trials

ObjectivesTo quantify the impact of a home-based cardiac rehabilitation intervention (Rehabilitation Enablement in Chronic Heart Failure (REACH-HF)) on objectively assessed physical activity (PA) of patients with heart failure (HF) and...

PS-C18-1: SLEEP SCORE AMONG HEALTH-RELATED QUALITY OF LIFE SUBSCALES PREDICTS TECHNIQUE SURVIVAL IN PATIENTS WITH PERITONEAL DIALYSIS

Purpose: There is sufficient evidence that peritoneal dialysis (PD) is superior to hemodialysis in terms of health-related quality of life (HRQOL), and higher HRQOL scores are associated with better clinical outcomes in patients with PD, however, the specific HRQOL subscales that predict prognosis remain uncertain. Design and method: In addition to various PD-related parameters and exercise capacity, HRQOL of outpatients with PD were assessed using Kidney Disease Quality of Life-Short Form Japanese version 1.3 from March 2017 to March 2018, and the association of HRQOL items with technique survival was prospectively analyzed until June 2021. Result: Among the 50 recruited PD outpatients, age and PD vintage were 63.8 ± 9.6 and 3.8 ± 2.8 years, respectively, and 21 patients discontinued PD and transferred to hemodialysis during the study period. In a univariate Cox proportional hazards model, higher scores (per 10) for symptoms, sleep, and vitality among HRQOL subscales were significantly associated with lower technique failure rate (Hazard Ratio(HR) 0.66, P = 0.002; HR 0.70, P = 0.006; and HR 0.80, P = 0.04, respectively). In multivariate analysis adjusted for Charlson comorbidity index, incremental shuttle walk test distance, and baseline PD vintage, only higher sleep score was significantly associated with lower technique failure rate (HR 0.68 per 10, P = 0.003). Among PD-related parameters, serum potassium level was significantly inversely correlated with sleep score (r = -0.34, P = 0.01). Discussion and Conclusion: Our results suggest that sleep score among HRQOL subscales is particularly useful as a predictor of technique survival in patients with PD. Improvement in sleep quality may improve technique survival in prevalent PD patients.

A More Intense Examination of the Intensity of Physical Activity in People Living with Chronic Obstructive Pulmonary Disease: Insights from Threshold-Free Markers of Activity Intensity.

Physical activity (PA) intensity of people living with chronic obstructive pulmonary disease (COPD) is typically evaluated using intensity thresholds developed in younger, healthier populations with greater exercise capacity and free from respiratory symptoms. This study therefore compared (i) PA differences between COPD and non-COPD controls using both traditional intensity thresholds and threshold-free metrics that represent the volume and intensity of the whole PA profile, and (ii) explored the influence of exercise capacity on observed differences. Moderate-to-vigorous physical activity (MVPA), average acceleration (proxy for volume, mg) and intensity distribution of activity were calculated for 76 individuals with COPD and 154 non-COPD controls from wrist-worn ActiGraph accelerometry. PA profiles representing the minimum intensity (acceleration, mg) during the most active accumulated 5–960 min were plotted. Estimated VO2peak and relative intensity were derived from the incremental shuttle walk test distance. Compared to the non-COPD control group, individuals with COPD recorded fewer MVPA minutes (59 vs. 83 min/day), lower overall waking activity (29.1 vs. 36.4 mg) and a poorer waking intensity distribution (−2.73 vs. −2.57). Individuals with COPD also recorded a lower absolute intensity (acceleration, mg) for their most active 5–960 min, but higher intensity relative to their estimated exercise capacity derived from the ISWT. People with COPD have a lower volume and absolute intensity of PA than controls but perform PA at a higher relative intensity. There is a need to move away from absolute intensity thresholds, and towards personalised or relative-intensity thresholds, to reflect reduced exercise capacity in COPD populations.

Comparison of physiological responses after incremental shuttle walking test and 6-minute walk test in patients with systemic sclerosis.

The 6‑minute walk test (6MWT) is acommonly used to evaluate exercise capacity in patients with systemic sclerosis (SSc), but there was no study using the incremental shuttle walking test (ISWT) for assessing exercise capacity and comparing the patient's cardiorespiratory responses to these tests. The aim was to investigate the usability and determinants of the ISWT in patients with SSc and compare the physiological responses after the ISWT and 6MWT. A total of thirty four female patients with SSc were included. Dyspnea during daily activities and knee extensor muscle strength was assessed, skin fibrosis and disease severity were recorded, and 6MWT and ISWT were carried out for the exercise capacity measurement. Pulmonary function test results were recorded from the individuals' medical records for SSc with interstitial lung disease (SSc-ILD) patients. The ISWT distance was significantly correlated with the 6MWT distance (p < 0.001). The 6MWT was correlated with age, modified Rodnan skin score, Medsger severity score, modified British Medical Research Council Questionnaire (mMRC) score, and knee extensor muscle strength (p < 0.05). The 6MWT was correlated with the forced expiratory volume in thefirstsecond (FEV1) (lt) and forced vital capacity (FVC) (lt) in patients with SSc-ILD (p < 0.05). The ISWT distance was correlated with age, modified Rodnan skin score, mMRC score, and knee extensor muscle strength (p < 0.05). Age, mMRC, and knee extensor muscle strength explained 33.8% of the variance in 6MWT distance, while age, mMRC, and knee extensor muscle strength explained 51.7% of the variance in the ISWT distance. Because of the higher cardiopulmonary responses, and having amore standardized procedure, the ISWT may be preferable for investigating symptom-limited exercise capacity in patients with SSc. Age, dyspnea, and knee extensor muscle strength were the determinants of exercise capacity in patients with SSc.

Comparison of Incremental Shuttle Walking Test, 6-Minute Walking Test, and Cardiopulmonary Exercise Stress Test in Patients with Myocardial Infarction.

BACKGROUND This study aimed to analyze the correlations among peak oxygen uptake (VO2) in cardiopulmonary exercise test (CPX), incremental shuttle walking test (ISWT), and 6-minute walking test (6MWT) distances in patients with myocardial infarction (MI). Additionally, we aimed to determine the relationship between the maximum heart rate (HRmax) and the rate of perceived exertion (RPE) among the tests and compare the changes in heart rate to verify the clinical benefit of the submaximal stress test. MATERIAL AND METHODS We analyzed the correlation by using the ISWT and 6MWT at 30-min intervals after 24 h of CPX in patients with MI. The differences in HRmax and RPE between the tests were also compared. Additionally, changes in heart rate were analyzed using descriptive statistics. RESULTS The ISWT distance was more strongly correlated with peak VO₂ (r=.823: 95% CI, 0.681-0.910) than was 6MWT (r=0.776: 95% CI, 0.683-0.870). HRmax in the CPX demonstrated a significant correlation with that in the ISWT and 6MWT (P<0.05), with the ISWT (r=0.815: 95% CI, 0.451-0.996) having a stronger correlation than the 6MWT (r=0.664: 95% CI, 0.146-0.911). The value of RPE was significantly different (P<0.05); however, there was no significant correlation. Changes in heart rate in the 6MWT plateaued after the initial increase, while the heart rate in the ISWT and CPX increased gradually. CONCLUSIONS We recommend the ISWT as a submaximal exercise test to evaluate exercise capacity in patients with MI.

Pulmonary rehabilitation versus usual care for adults with asthma.

Pulmonary rehabilitation versus usual care for adults with asthma.

MO600: Effects of Intradialytic Progressive Resistance and Aerobic Exercise Training on Physical Function

Abstract BACKGROUND AND AIMS Haemodialysis (HD) patients frequently experience reduced physical function, which is exacerbated throughout dialysis vintage, therefore compromising their quality of life. Despite recent studies highlighting improvements in physical function regardless of exercise modality, well-designed randomized controlled trials with progressive resistance exercise training protocols are scarce. Thus, this study investigated the effects of 12 weeks of intradialytic progressive resistance exercise (RE) and aerobic exercise (AE) training on physical function in HD patients. METHOD Fifty-six adult HD patients from three NephroCare Portugal SA clinics were included in this study. Following a 6-week run-in control period, participants were randomly allocated into either a supervised intradialytic AE [(n = 29, male: 66%, age: 66 ± 16 years)] or RE [(n = 27, male: 67%, age: 63 ± 14 years)] training protocol, 3 sessions per week for 12 weeks. Intradialytic RE training consisted of 2 sets of 12 repetitions of 8 different exercises for upper and lower body using free-weight dumbbells and a newly designed weight machine, while intradialytic AE training was performed on a cycle ergometer at 50–70 rpm for 30 min at a rating of perceived exertion (RPE) 12–14 (Borg scale). Physical function was assessed by completing the Sit to Stand 60 (STS-60) test, the Short Physical Performance Battery (SPPB), the Incremental Shuttle Walk Test (ISWT), the Timed Up and Go (TUG) test and isometric handgrip strength (HGS) on three occasions: before and after the 6-week run-in control, and after the 12-week exercise periods. The 6-week control period data were analyzed by paired sample t-tests or Wilcoxon rank test as this is prior to randomization. Training effects were examined using an ANOVA with mixed design (within- and between-subjects) for data with normal distribution or if data still with non-normal distribution after log transformation, Wilcoxon rank test (within subjects) and Mann–Whitney test (between subjects) were used with a significance value of P &amp;lt; 0.05. RESULTS There was no change in any variable when comparing before and after the 6-week control period (P &amp;gt; 0.05). AE and RE training significantly increased the number of repetitions performed on the STS-60 test compared to before the 12-week intervention, but had no effect on the SPPB scores. Additionally, despite no changes in the distance covered in ISWT in the AE group, AE training reduced the TUG time and an increase in HGS was observed. On the other hand, patients that performed RE training increased their walking distance in ISWT. However, no change in HGS was observed. Yet, and despite not impactful, a 0.1 s significant increase in the median time performed on the TUG test was also observed. Nevertheless, no changes between groups were observed after the 12-week exercise intervention (Table 1). CONCLUSION We conclude that 12 weeks of AE training seem to improve HGS, STS-60 and TUG test performance in HD patients, whereas progressive RE training only had an effect on the STS-60 and ISWT performance in these patients. This may suggest that HD patients can benefit from different exercise interventions which can improve their overall physical function. FUNDING Portuguese Foundation of Science and Technology (SFRH/BD/138 940/2018 and UID/04 045/2020). ACKNOWLEDGEMENTS We would like to acknowledge the support of NephroCare Portugal, the University of Maia staff, MSc students and all study participants for their collaboration.

The effectiveness of pulmonary rehabilitation on chronic obstructive pulmonary disease patients with concurrent presence of comorbid depression and anxiety

BackgroundWe examined the prevalence of comorbid depression and anxiety in patients with chronic obstructive pulmonary disease (COPD) and their response to eight-weeks of pulmonary rehabilitation (PR). MethodsSeven hundred thirty four patients with clinically stable COPD completed an eight-week outpatient multidisciplinary PR, comprising 2-h (1-h exercise and 1-h education) per/week. Depression and anxiety, exercise capacity, quality of life (QOL), and dyspnea were measured pre- and post-PR by the incremental shuttle walk test (ISWT), St. George's Respiratory Questionnaire (SGRQ), and modified Medical Research Council (mMRC) scale, respectively. The Depression Anxiety Stress Scale (DASS-21) was completed and patients classified as having clinically significant comorbid anxiety and depression, anxiety alone, depression alone, or with neither. ResultsThe mean (SD) age of patients was 71 (8.8) years, and 51% were men. Prevalence of pre-PR comorbid depression and anxiety was 34%, anxiety alone 20%, depression alone 5% and neither 41%. The prevalence of stress was 59%. In patients with anxiety and depressive symptoms, total SGRQ score improved from 64.9 (13.8) pre-PR to 50.1 (17.2) post PR (p < 0.001), mMRC score improved from 3.4(1.0) pre-PR to 2.8 (1.1) post PR (p < 0.001), and ISWT distance walked increased from 188.6 (117.6) pre-PR to 248.6 (149.1) post PR, p < 0.001. ConclusionOne in three patients with COPD suffer from comorbid depression and anxiety with a high level of disease burden, reflected by symptoms of elevated dyspnea and impaired QOL. PR improves QOL and exercise capacity, and reduces dyspnea in patients with COPD and comorbid depression and anxiety.

Stronger correlation of peak oxygen uptake with distance of incremental shuttle walk test than 6-min walk test in patients with COPD: a systematic review and meta-analysis

BackgroundThe 6-min walk test (6MWT) and incremental shuttle walk test (ISWT) are valid and reliable measures to assess exercise capacity of patients with chronic obstructive pulmonary disease (COPD). However, the comparison of correlation between peak oxygen uptake (peak VO2) and 6MWT or ISWT distance has not been investigated. We aimed to investigate the correlation between peak VO2 and 6MWT and ISWT distances in COPD patients through a meta-analysis.MethodsWe systematically searched MEDLINE, Scopus, Embase, and the Cochrane Library up to June, 2020 for studies comparing the correlation of peak VO2 with either 6MWT or ISWT in COPD patients. Meta-analysis was performed with R software using a fixed-effect model. We compared the correlation coefficient and measured the heterogeneity using I2 statistics.ResultsWe identified 12 studies involving 746 patients. Meta-analysis showed a significant correlation between peak VO2 and 6MWT and ISWT distances (6MWT: r = 0.65, 95% CI 0.61–0.70; ISWT: r = 0.81, 95% CI 0.74–0.85; p < 0.0001). The heterogeneity was lower in ISWT than in 6MWT (6MWT: I2 = 56%, p = 0.02; ISWT: I2 = 0%, p = 0.71). Subgroup analysis showed a higher correlation coefficient in the low exercise capacity group than in the high exercise capacity group in both field tests.Conclusions6MWT and ISWT significantly correlated with peak VO2. Our findings suggest that ISWT has a stronger correlation with peak VO2 than 6MWT. The exercise capacity in COPD patients may affect the strength of the relationship between peak VO2 and walking distance in both field tests, suggesting the importance of using various exercise tests.Trial registration CRD 42020200139 at crd.york.ac.uk/prospero/

CMR Measures of Left Atrial Volume Index and Right Ventricular Function Have Prognostic Value in Chronic Thromboembolic Pulmonary Hypertension.

Providing prognostic information is important when counseling patients and planning treatment strategies in chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to assess the prognostic value of gold standard imaging of cardiac structure and function using cardiac magnetic resonance imaging (CMR) in CTEPH. Consecutive treatment-naive patients with CTEPH who underwent right heart catheterization and CMR between 2011 and 2017 were identified from the ASPIRE (Assessing-the-Specturm-of-Pulmonary-hypertensIon-at-a-REferral-center) registry. CMR metrics were corrected for age and sex where appropriate. Univariate and multivariate regression models were generated to assess the prognostic ability of CMR metrics in CTEPH. Three hundred and seventy-five patients (mean+/-standard deviation: age 64+/-14 years, 49% female) were identified and 181 (48%) had pulmonary endarterectomy (PEA). For all patients with CTEPH, left-ventricular-stroke-volume-index-%predicted (LVSVI%predicted) (p = 0.040), left-atrial-volume-index (LAVI) (p = 0.030), the presence of comorbidities, incremental shuttle walking test distance (ISWD), mixed venous oxygen saturation and undergoing PEA were independent predictors of mortality at multivariate analysis. In patients undergoing PEA, LAVI (p < 0.010), ISWD and comorbidities and in patients not undergoing surgery, right-ventricular-ejection-fraction-%predicted (RVEF%pred) (p = 0.040), age and ISWD were independent predictors of mortality. CMR metrics reflecting cardiac function and left heart disease have prognostic value in CTEPH. In those undergoing PEA, LAVI predicts outcome whereas in patients not undergoing PEA RVEF%pred predicts outcome. This study highlights the prognostic value of imaging cardiac structure and function in CTEPH and the importance of considering left heart disease in patients considered for PEA.

Decreased incremental shuttle walk test distance characterized by fibrocavitary lesions in non-tuberculous mycobacterial pulmonary disease

Background Patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD) have impaired exercise capacity, but the underlying factors are unknown. We investigated the characteristics of patients with NTM-PD and impaired exercise capacity. Methods In total, 149 patients with NTM-PD participated in this study. Patients completed the incremental shuttle walk test (ISWT) to assess exercise capacity. Peripheral muscle strength and pulmonary function were also assessed. Radiological findings were classified into three phenotypes: non-cavitary nodular bronchiectatic (NC-NB) form, cavitary nodular bronchiectatic form, and fibrocavitary (FC) form. Results The median ISWT distance (ISWD) and %ISWD were 450 meters and 88%. Participants were classified into three groups according to %ISWD, with %ISWD <60% as the severely decreased group, 60%-80% as the moderately decreased group, and >80% as the normal or mildly decreased group. In a comparison of %ISWD among phenotypes, FC form had significantly lower %ISWD than those with NC-NB form. In the severely decreased group, peripheral muscle strength and pulmonary function were significantly lower than the other two groups. From a radiological standpoint, significantly more patients had FC form in the group with severely decreased %ISWD. Conclusions Decreased ISWD is characterized by a deterioration in physical function and the presence of FC lesions in NTM-PD.

Preoperative incremental shuttle walk test for morbidity and mortality prediction in elective major colorectal surgery.

Background and Aims:The incremental shuttle walk test (ISWT) is a simple reproducible and non-invasive test for assessing cardiopulmonary function. The maximum oxygen consumption is less than 10 ml/kg/min for ISWT distance of less than 250 m. This study aimed to evaluate the effectiveness of ISWT in predicting morbidity and mortality in elective colorectal oncosurgery and to find the correlation of ISWT with the Duke Activity Status Index (DASI), Borg dyspnoea score, and peak oxygen uptake (VO2 max).Methods:This prospective study involved 46 patients aged more than 60 years with American Society of Anesthesiologists physical status I and II undergoing elective colorectal surgery under general anaesthesia with an epidural block. ISWT was conducted preoperatively and patients were monitored for 30 days postoperatively. For a comparative analysis, patients were divided into two groups: group 1– who could walk 250 m and group 2 – could not walk 250m. Categorical data were evaluated using the Chi-square test, while continuous data were evaluated using the Student’s t-test. The strength of correlation was determined using Pearson’s correlation coefficient.Results:Postoperative complications (P = 0.001) and lengthy stay in hospital and intensive care unit (P = 0.001) were experienced by all patients who were unable to complete the ISWT distance of 250 m. ISWT distance of 250 m corresponds to a DASI score of 10.5, which is equivalent to a calculated VO2 max of 14.1ml/kg/min.Conclusion:The ISWT with a cutoff distance of 250 m is a reliable predictor of postoperative morbidity in patients undergoing colorectal oncosurgery.

In-hospital pulmonary rehabilitation after completion of primary respiratory disease treatment improves physical activity and ADL performance: A prospective intervention study.

Introduction:Pulmonary rehabilitation improves the physical condition of patients with chronic respiratory disease; however, there are patients who cannot leave the hospital because of their low activities of daily living (ADLs), despite the completion of primary respiratory disease treatment and rehabilitation during treatment. Therefore, this study demonstrated that those patients recovered their ADLs through in-hospital pulmonary rehabilitation after treatment completion.Methods:We prospectively studied 24 hospitalized patients who had some remaining symptoms and showed low ADL scores of 9 points or less on the short physical performance battery after undergoing treatment for respiratory disease in Fukujuji Hospital from October 2018 to October 2019, excluding 2 patients who had re-exacerbation and 1 patient who could not be examined using the incremental shuttle walk test (ISWT). After completion of the primary respiratory disease treatment, patients moved to the regional comprehensive care ward, and they received pulmonary rehabilitation for 2 weeks. In the ward, patients who could not yet leave the hospital could undergo pulmonary rehabilitation for up to 60 days. Data were evaluated three times: upon treatment completion (baseline), postrehabilitation, and 3 months after baseline. The main outcome was an improvement in the incremental shuttle walk test (ISWT) postrehabilitation.Results:The median age of the patients was 80 (interquartile range (IQR): 74.8–84.5), and 14 patients (58.3%) were male. The ISWT distance significantly increased postrehabilitation (median [IQR]: 60 m [18–133] vs 120 m [68–203], P < .001). The Barthel Index (BI) (P < .001), the modified Medical Research Council (P < .001), and other scale scores were also improved. Among patients with acute respiratory diseases such as pneumonia, chronic obstructive pulmonary disease, and interstitial pneumonia, ISWT and other data showed improvement at the postrehabilitation timepoint. Ten patients who could perform examinations at 3 months after baseline were evaluated 3 months after taking baseline data prior to starting rehabilitation. The ISWT showed significant improvement 3 months after baseline compared to baseline (P = .024), and the ISWT distance was maintained after rehabilitation.Discussion and conclusions:Physical activity, symptoms, mental health, and ADL status in patients who had not recovered after primary treatment completion for respiratory diseases could improve through in-hospital pulmonary rehabilitation.

Incremental Shuttle Walk Test and Body Composition Measures: Useful Predictive Factors For Complications After Oesophago-Gastric Cancer Surgery?

Background: Oesophagogastric cancer resection carries a morbidity, as high as 60%. Better patient selection, not only with regards to clinical stage but also fitness, reduces morbidity, and improves outcome. Assessment of body composition measures in particular sarcopenia and the incremental shuttle walk test (ISWT) are 2 such tools to evaluate patients’ fitness. We investigate the usefulness of these 2 tools in predicting post-operative outcomes following oesophagogastric resection. Methods: All patients who underwent oesophagogastric cancer resection between 2017 and 2019 and consented to participate in ISWT were included in the study. Patient demographics, comorbidity profile and distance walked in ISWT were collected from an electronic database kept locally. Body composition measures were calculated using pre-operative staging CT scans. Outcomes assessed included overall complications, major complications (Clavien-Dindo III-V) and overall survival. Results: Sixty-seven patients met the inclusion criteria. Seventy-nine percent of the cohort were males and the median age was 67. The majority had neoadjuvant chemotherapy (85%) and the overall complication rate was 69% with a major complication rate of 34%. There was no difference in complication rates between groups of patients who managed an ISWT distance of &gt;350 m and ≤350 m. Multi-variate analyses showed that total fat index ( P = .041), myosteatosis (OR: 3.89; 95% CI: 1.04-16.76; P = .039) and sarcopenic obesity ( P = .028) were independent predictors of overall complications. The presence of sarcopenic obesity was associated with poorer overall survival ( P = .047). There was no correlation between skeletal muscle index and ISWT. Conclusion: ISWT does not predict post-operative morbidity following oesophagogastric cancer resection. However, sarcopenic obesity was associated with both higher overall complication rates and decreased overall survival. The assessment of body composition using CT scans is a useful pre-operative assessment tool for prediction of outcomes in patients undergoing oesophagogastric cancer resection

Abstract 13581: Heart Rhythm versus Heart Rate Control Strategy in Patients With Pre-Capillary Pulmonary Hypertension and Atrial Arrhythmias

Introduction: Atrial tachyarrhythmias in patients with pre-capillary pulmonary hypertension are often poorly tolerated leading to increased morbidity and mortality. Sinus rhythm restoration seems to improve outcomes but a direct comparison between rate and rhythm control has not been investigated. We sought to determine any difference in effectiveness between the two strategies. Methods: We performed a retrospective study in 88 patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) and new-onset atrial flutter or fibrillation seen in our centre from 2005-2020. Patients were divided into 3 groups based on management strategy: rate control (n=20), rhythm control with medication only (n=24) and rhythm control with DC cardioversion (DCCV) and medication (n=44) (Table 1). Differences in WHO functional class and incremental shuttle walk test distance (ISWTD) at arrhythmia onset and after treatment were measured. Results: Sinus rhythm was successfully restored in 42/44 (95%) of patients treated with DCCV and medication compared to 13/24 (54%) treated with amiodarone only (p&lt;0.001). Cardioverted patients reported a significant improvement in functional class compared to patients treated with rate control (p&lt;0.001). A similar improvement in ISWTD (≥15%) was also reported (p=0.004) (Table 2). No serious complications were reported with either strategy. Conclusions: A rhythm control strategy including DCCV and medication is a safe and effective way to restore sinus rhythm in patients with PAH/CTEPH and atrial tachyarrhythmias. Restoration and maintenance of sinus rhythm led to an improvement in their functional status.

The Incremental Shuttle Walk Test

The Incremental Shuttle Walk Test

The prognostic value of the Incremental Shuttle Walk Test in Chagas cardiomyopathy

Purpose To verify the value of the Incremental Shuttle Walk Test (ISWT) distance to identify patients with Chagas cardiomyopathy (ChC) at risk of adverse cardiovascular events. Methods Fifty-two patients with ChC (51 ± 6 years) were evaluated by ISWT, echocardiography, Cardiopulmonary Exercise Testing, and Human Activity Profile (HAP) Questionnaire. Patients were prospectively followed for 44 ± 10 months. The combined endpoint was cardiac death/heart transplant/stroke. The prognostic value of ISWT was verified by the Cox regression, and the ISWT was adjusted for age, sex, left ventricular ejection fraction (LVEF), and minute ventilation/carbon dioxide production relationship (VE/VCO2 slope). Results At the final follow-up, 11 patients (21%) had experienced the endpoint event. When adjusted for age, sex, LVEF, and VE/VCO2 slope, only ISWT distance (HR 0.99, 95% confidence interval (CI): 0.98–0.99; p = 0.026) and VE/VCO2 slope (HR 0.93, 95% CI: 0.87–0.99; p = 0.044) remained as independent predictors of adverse cardiovascular events in patients with ChC. The optimal cutoff point for identifying poor prognosis was the ISWT distance less than 440 m (AUC = 0.72). There was a significant difference (p = 0.032) in the number of events between the groups with low ISWT distance (≤440 m) and high (>440 m) ISWT distance. Conclusions The ISWT is a valuable tool with potential value in the prognostic evaluation of patients with ChC. Implications for rehabilitation Patients with Chagas cardiomyopathy showed functional impairment since the early stages of heart disease. The Incremental Shuttle Walk Test (ISWT) can be a valuable and inexpensive tool in the risk stratification of the patients. The ISWT distance is an independent predictor of adverse cardiovascular event. The ISWT distance of 440m is the optimal cut-off point in the identification of patients at risk for adverse cardiovascular events.