Median Walking Distance Research Articles

Oxygen saturation measurement in cyanotic heart disease with the Apple watch.

Accurate measurement of transcutaneous oxygen saturation is important for the assessment of cyanosis in CHD. Aim of this study was the evaluation of a supplementary transcutaneous oxygen saturation measurement with an Apple watch® in children with cyanotic heart disease. During a six-minute walk test, measurement of transcutaneous oxygen saturation was performed simultaneously with an Oximeter (Nellcor, Medtronic, USA) and an Apple watch® Series 7 (Apple inc, USA) in 36 children with cyanotic heart disease. Median age was 9.2 (IQR 5.7-13.8) years. Transcutaneous oxygen saturation measurement with the Apple watch® was possible in 35/36 and 34/36 subjects before and after six-minute walk test. Children, in whom Apple watch® measurement was not possible, had a transcutaneous oxygen saturation < 85% on oximeter. Before six-minute walk test, median transcutaneous oxygen saturation was 93 (IQR 91-97) % measured by oximeter and 95 (IQR 93-96) % by the Apple watch®. After a median walking distance of 437 (IQR 360-487) m, transcutaneous oxygen saturation dropped to 92 (IQR 88-95, p < 0.001) % by oximeter and to 94 (IQR 90-96, p = 0.013) % measured with the Apple watch®. In children with mild cyanosis measurement of transcutaneous oxygen saturation with an Apple watch® showed only valid results if transcutaneous oxygen saturation was > 85%, with higher values being measured with the smart watch. In children with moderate or severe cyanosis transcutaneous oxygen saturation, measurement with the Apple watch® was not reliable and cannot be recommended to monitor oxygen saturation at home.

The 1-minute sit-to-stand test to evaluate fibrotic interstitial lung disease

IntroductionFibrotic interstitial lung diseases (ILD) are a heterogeneous group of conditions. Progression criteria include clinical, imaging, and/or lung functional decline. Currently, the 6-minute walk test (6MWT) is considered the gold standard for assessing exercise-induced desaturation. The 1-minute sit-to-stand test (1STST) has the advantage of being easy to perform, making it feasible for use during clinical consultations. The aim of this study was to compare the 1STST with the 6MWT in patients with fibrotic ILD to detect exercise-induced desaturation. MethodsA multicenter cross-sectional involved patients with fibrotic ILDs from two centers. The 6MWT and 1STST were performed with a 30-minute rest period between the tests. The modified Borg scale was used to assess dyspnea and lower limb fatigue and continuous SpO2 and heart rate were monitored. Desaturation was defined as SpO2 < 90% or decline >3%. ResultsNinety patients were included. The median walking distance in the 6MWT was 432 meters and the median number of repetitions in the 1STST was 22, with a significant correlation (p<0.001, ρ=0.383). In addition, the minimum SpO2 and the desaturation levels recorded during the tests exhibited a moderate significant correlation (p<0.001, ρ=0.502 and p<0.001, ρ=0.537, respectively). There was a strong association between the increase in Borg score for dyspnea and a moderate association between the increase in Borg score for lower limb fatigue after both tests (p<0.001, ρ=0.706 and p<0.001, ρ=0.656, respectively). ConclusionsThis study demonstrates a significant correlation between the 6MWT and the 1STST in detecting exercise-induced desaturation.

Safety and Efficacy of the Passeo-18 Lux Drug-Coated Balloon Catheter in Atherosclerotic Femoropopliteal Lesions: The Multicenter BIOLUX P-IV China Study

The purpose of this trial was to assess the safety and effectiveness of a paclitaxel-coated balloon catheter in Chinese patients with de novo or nonstented restenotic femoropopliteal atherosclerotic lesions. BIOLUX P-IV China is a prospective, independently adjudicated, multicenter, single-arm trial conducted in China. Patients with Rutherford class 2-4 were eligible, excluded were patients in which predilation resulted in severe (≥ grade D) flow-limiting dissection or residual stenosis > 70%. Follow-up assessments were conducted at 1, 6, and 12months. The primary safety end point was 30-day major adverse event rate and the primary effectiveness end point was primary patency at 12months. We enrolled 158 patients with 158 lesions. Mean age was 67.6±9.6years, diabetes was present in 53.8% (n=85), and previous peripheral intervention/surgeries in 17.1% (n=27). Lesions were 4.1±0.9mm in diameter and 74±50mm long with a mean diameter stenosis of 91±13%; 58.2% (n=92) were occluded (core laboratory analysis). Device success was achieved in all patients. The rate of major adverse events was 0.6% (95% confidence interval: 0.0; 3.5) at 30days, consisting of 1 target lesion revascularization. At 12months, binary restenosis was present in 18.7% (n=26) and target lesion revascularization was performed in 1.4% (n=2, all clinically driven), resulting in a primary patency of 80.0% (95% confidence interval: 72.4, 85.8); no major target limb amputation occurred. Clinical improvement at 12months, defined as improvement of at least 1 Rutherford class, was 95.3% (n=130). The median walking distance per 6-minute walk test was 279m at baseline and improved by 50m at 30days and by 60m at 12months; the visual analogue scale changed from 76.6±15.6 at baseline to 80.0±15.0 at 30days and 78.6±14.6 at 12months. Our results confirmed the clinical effectiveness and safety of a paclitaxel-coated peripheral balloon dilatation catheter for the treatment of de novo and nonstented restenotic lesion of the superficial femoral and proximal popliteal artery in Chinese patients (NCT02912715).

Changes in retail food environments around schools over 12 years in Flanders, Belgium

Abstract Background Food environments influence food preferences, in particular among children. Besides their homes, children spend most of their time in and around the school. This study mapped changes in retail food environments around primary and secondary schools in Flanders between 2008 and 2020. In addition, associations between those indicators and children's weight status were assessed. Methods The food environment near primary and secondary schools was mapped using three spatial indicators: 1) The density of different types of food retailers within 1000m road distance from the school entrance, 2) the percentage of schools with at least one food retailer of a certain type within 1000m road distance from the entrance, and 3) the median walking distance from the school entrance to the nearest food retailer of a certain type. Associations between the density of convenience stores, as well as fast food outlets around the schools and the weight status of the schools’ children were assessed using generalized linear models adjusted for level of urbanization, socio-economic status of children at school level and sex. Results Food environments near schools in Flanders were found to be unhealthy, with a significant increase in fast-food outlets and convenience stores between 2008 and 2020. Food environments near schools with a higher proportion of children from a poor socio-economic background were found more unhealthy than those near schools with a lower proportion of such children, regardless of the urbanization level. A significant positive association was found between the density of fast food outlets as well as convenience stores around primary schools and the weight status of children aged &amp;lt;6 years and 6-12 years. Conclusions Food environments around schools in Flanders became more unhealthy over time and were associated with children's weight status. The government therefor has the responsibility to create healthy food environments near schools to protect children's health. Key messages • The food environment near schools became more unhealthy between 2008 and 2020. • The food environment near schools was associated with younger children's weight status.

Assessment of Six-Minute Walk Test Among Discharge-Ready Severe COVID-19 Patients: A Cross-Sectional Study.

BackgroundAmong patients hospitalized for severe pneumonia due to coronavirus disease (COVID-19), clinical stability and normal resting peripheral oxygen saturation (SpO2) levels are widely used as a discharge criterion after recovery. It is unknown whether a test to assess the functional exercise capacity, like a six-minute walk test (6MWT), can add to the appropriateness of discharge criteria.MethodsA cross-sectional study was conducted at a tertiary care COVID-19 hospital in India from 01st to 31st May 2021. All patients considered fit for discharge after recovery from "severe" COVID-19 pneumonia were subjected to 6MWT. Fitness for discharge was assessed by clinical stability and resting SpO2 above 93% for three consecutive days. Patients were considered to have failed the 6MWT if there was ≥4% fall in SpO2 or if they could not complete the test. Serum samples were analyzed for levels of C-reactive protein (CRP), interleukin-6 (IL-6), and lactate dehydrogenase (LDH) at the time of discharge.ResultsFifty-three discharge-ready patients with a mean age of 54.54 ± 14.35 years with a male preponderance (60.38%) were analyzed. Thirty-three (62.26%) patients failed the 6MWT with a median six-minute walk distance (6MWD) of 270 m (60-360). A total of 45 (84.91%) patients had a fall in SpO2 during the test. The median change in SpO2 (∆SpO2) was 5% ranging from -6% to 8%. Serum LDH was significantly higher among patients who failed the 6MWT with a median LDH of 334 IU/L (38.96-2339) versus 261 IU/L (49.2-494) (p = 0.02). The difference was not significant for CRP or IL-6. There was no statistically significant correlation between the inflammatory markers with either 6MWD or (∆SpO2).ConclusionTwo-thirds of the patients considered fit for discharge after recovery from severe COVID-19 pneumonia failed 6MWT, implying reduced functional exercise capacity and exertional hypoxia. Serum LDH levels were higher in these patients but not in other inflammatory markers. None of the inflammatory markers at discharge correlated with 6MWD or ∆SpO2 of 6MWT.

The Factors Related to the 6 Minute Walk Test: The Experience of a Referral Lung Transplantation Center

Objectives: The 6-minute-walk test is a practical and widely used test, which indicates the exercise capacity in patients with a severe pulmonary disease. The study aims to investigate the related factors with the 6-minute-walk test in lung transplantation candidates.&#x0D; Materials and Method: The data were collected retrospectively from 349 patients, between January 2012 and September 2020. The patients were grouped according to their underlying lung disease as obstructive lung diseases, interstitial lung diseases, and infective lung diseases. The data collected included patient demographics, gender, body mass index, artery blood gas, the results of the respiratory function test, six-minute walk test, long-term oxygen therapy, and the need for non-invasive mechanical ventilation [such as group 1 (6MWD&lt;200) and group 2(6MWD≥200)]. All of the collected data were analyzed and compared between the groups.&#x0D; Results: Overall, 349 patients were included in the study, and there were 123 females and 226 males (35.2% and 64.8% respectively) with a mean age of 46.92 ± 14.1 years. Their mean body mass index was 23.58 ± 12.52 kg/m2, the median FEV1(%) was 35.3 (33.4-37.2), the median six-minute walk distance was 222 m (125-335 m), and the mean PaO2/FiO2 (P/F) was 250.32% ± 74.81, the mean PCO2 was 45.71 mmHg ± 11.97. Furthermore, the patients using long-term oxygen therapy were (n=274, 78.5%) and non-invasive mechanical ventilation were (n=125, 35.8%). The mortality status, P/F, long-term oxygen therapy usage, and non-invasive mechanical ventilation usage were different between Group 1 and Group 2 (p=0.001, p=0.001, p&lt;0.001, and p&lt;0.001, respectively). There was no difference between the groups in patients with and without IPF between underlying diseases. The 6-minute walk test was found to have moderate correlation with FEV1 and P/F; and a negative correlation with age and PCO2 (p&lt;0.01, r=0.33.8, p&lt;0.001, r= 38.1 and p=0.17, r=12,7, p&lt;0.001, r=-0.30.6, respectively). There was no correlation between P/F, FEV1, and body mass index; and also, between PCO2, age, and body mass index. Age had a weak correlation with FEV1(p&lt;0.001, r=19.3). There was no correlation between the age and 6MWD, as well as P/F, PCO2, and the body mass index. The factors affecting survival in multivariate analysis were investigated by using the Cox regression model. It was observed that gender (OR, 0.001; 95% CI, 0.246-0.716; p=0.42), FEV1(OR, 1.02; 95% CI, 1.00-1.04; p&lt;0.001), P/F (OR, 1.00; 95% CI, 1.00-1.01; p&lt;0.001), and LTOT (OR, 9.83; 95% CI, 3.70-26.14; p&lt;0.001) were independent factors associated with 6MWD&lt;200 m.&#x0D; Conclusion: The 6-minute walk test is associated with mortality, gender, poor oxygenation, and with the utilization of domiciliary non-invasive mechanical ventilation or long-term oxygen therapy. Furthermore, it is an independent risk factor for mortality in lung transplant candidates and in providing a valuable method for the management of patients.

Experience with pulmonary endarterectomy: Lessons learned across 17 years.

Pulmonary endarterectomy is potential curative therapy for chronic thromboembolic pulmonary hypertension patients. Here, we present our experience with pulmonary endarterectomy spanning 17 years and detail our management strategy. This is a single-centre retrospective study conducted on chronic thromboembolic pulmonary hypertension patients who underwent pulmonary endarterectomy at our centre across 17 years. Between 2004 and 2020, 591 patients underwent pulmonary endarterectomy. Amongst them 429 (72.4%) were males with a male to female ratio of 2.6:1, the median age was 38 (range, 14-73) years. The median length of hospital stay was 11 days (IQR, 8-16). Extra corporeal membranous oxygenation was used in 82 (13.9%) patients during/after surgery, out of whom 28 (34.1%) survived. There were 70 (11.8%) in-hospital deaths. Female gender (p < 0.01), pulmonary artery systolic pressure >100 mmHg (p < 0.05) and use of extra corporeal membrane oxygenation (p < 0.001) were significant risk factors for in-hospital mortality. The mortality in the first period (2004-2012) was 15.7% which reduced to 9.1% in the later period (2013-2020). The reduction in mortality rate was 42% (p < 0.05). Following pulmonary endarterectomy, there was a significant reduction in pulmonary artery systolic pressure (86.68 ± 24.38 vs. 39.71 ± 13.13 mmHg; p < 0.001) and improvement in median walk distance as measured by 6-min walk test on follow-up (300 vs. 450 meters; p < 0.001). The median duration of follow-up was 8 months (inter-quartile range: 2-24). pulmonary endarterectomy has a learning curve, high pulmonary vascular resistance alone is not a contraindication for surgery. Patients following surgery have improved survival and quality of life.

Echocardiographic predictors of exercise capacity in algerian patients with heart failure and systolic dysfunction: role of mitral regurgitation

Patients with heart failure and similar left ventricular systolic dysfunction have differing exercise capacity. The aim of this study was to identify echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction. We included 290 patients with class II (70%) or III (30%) heart failure with left ventricular ejection fraction below 40%. Six-minute walking test and cardiac color Doppler-echo, including tissue Doppler of mitral and tricuspid rings, were performed. Moderate and severe mitral regurgitation were considered as significant. Two groups were divided according to the median walking distance (290 m): Group 1 < 290 m and Group 2 > 290 m. Mitral regurgitation was detected in 215 patients (74%), which was significant in 87 (30%). Group 1 showed more significant mitral regurgitation (35 vs. 18%), increased left atrium area (27 ± 1 vs. 241 cm2), mitral E amplitude (88 ± 65 vs. 72 ± 3 cm/s) and systolic pulmonary pressure (37 ± 1 vs. 32 ± 1 mmHg, all P < 0.05). By logistic regression analysis, only the presence of significant mitral regurgitation was independently associated with less walked distance (odds ratio: 3.44 95% confidence interval 1.02-11.66, P < 0.05). By multiple linear regression, the only independent predictor of walked distance was left atrium area (r = 0.25, beta coefficient: _6.52 ± 2, P < 0.01). In patients with class II-III heart failure and left ventricular systolic dysfunction, the main echocardiographic predictors of exercise capacity are related to the presence of significant mitral regurgitation.

Echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction: Role of mitral regurgitation

Patients with heart failure and similar left ventricular systolic dysfunction have differing exercise capacity. The aim of this study was to identify echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction. We included 150 patients with class II (70%) or III (30%) heart failure with left ventricular ejection fraction below 40%. Six-minute walking test and cardiac color Doppler-echo, including tissue Doppler of mitral and tricuspid rings, were performed. Moderate and severe mitral regurgitation were considered as significant. Two groups were divided according to the median walking distance (290 m): Group 1 < 290 m and Group 2 > 290 m. Mitral regurgitation was detected in 112 patients (75%), which was significant in 40 (27%). Group 1 showed more significant mitral regurgitation (35 vs. 18%), increased left atrium area (27 ± 1 vs. 24+ ± 1 cm 2 ), mitral E amplitude (88 ± 65 vs. 72 ± 3 cm/s) and systolic pulmonary pressure (37 ± 1 vs. 32 ± 1 mmHg, all P < .05). By logistic regression analysis, only the presence of significant mitral regurgitation was independently associated with less walked distance (odds ratio: 3.44 95% confidence interval 1.02–11.66, P < .05). By multiple linear regression, the only independent predictor of walked distance was left atrium area ( r = 0.25, beta coefficient: _6.52 ± 2, P < .01). In patients with class II-III heart failure and left ventricular systolic dysfunction, the main echocardiographic predictors of exercise capacity are related to the presence of significant mitral regurgitation.

Distances walked to and from local destinations: Age-related variations and implications for determining buffer sizes

IntroductionNeighborhood environmental attributes can influence health-related physical activity, particularly walking. A better understanding of the distances adults walk to local destinations is needed to identify the appropriate geospatial boundaries within which environmental attributes are measured (buffer sizes). This study sought to identify the distances adults of different ages walk to/from public transit (PT) stops, shops/services, and natural features. MethodsData from the 2009–12 South-East Queensland Travel Survey were used. Our sample consisted of 2105 adults (18–84 years) who reported at least one home-based walking trip to/from those destinations. We reported the median (with the 20th and 80th percentiles) distances walked to/from each destination category by age groups. Multilevel regression analyses examined whether the distances walked differed by age groups. ResultsParticipants reported 4029 walking trips, with the median distance of 0.68 km and the 80th percentile of 1.35 km. The median walking distance (80th percentile) to/from utilitarian destinations (PT stops, shops/services) and natural features was 0.63 (1.16) km and 1.15 (2.27) km, respectively. The overall median walking distance by age groups was 0.62 km for the younger (18–34 years), 0.67 km for younger middle (35–49 years), 0.79 km for older middle (50–64 years) and 0.72 km for older (65–84 years) groups. Regression analyses found that older middle-aged adults walked significantly longer overall and to/from utilitarian destinations than any of the other age groups. ConclusionsOur findings support buffer sizes around 600–1200 m for studies examining environmental correlates of walking for utilitarian purposes. For recreational walking to get to natural features, larger buffer sizes ranging from 1200 to over 2000 m may be suitable. We did not find consistent evidence supporting the use of different buffer sizes for different age groups.

Decrease in Cerebral Oxygen Saturation During the 6-Minute Walk Test in Pediatric Pulmonary Arterial Hypertension.

This observational study aimed to investigate the relationship between regional cerebral oxygen saturation (rSO2) during the 6-minute walk test (6-MWT) and the demographic/clinical features of patients with pulmonary arterial hypertension (PAH). Cerebral oxygenation was evaluated during the 6-MWT in 20 pediatric patients with PAH aged ≥ 7years [13 male, 7 female; median age 12.25 (range 7-18) years]. In all patients, regional cerebral oxygen saturation (rSO2), arterial oxygen saturation (SpO2), and heart rate (HR) were measured using near-infrared spectroscopy (NIRS) for 2min before the test, during the 6-MWT test, and 2min after the test. The relationship between the changes in rSO2, heart rate, and SpO2 values and clinical and laboratory features was compared statistically. The mean pulmonary arterial pressure (mPAP) was 77 (range 25-126) mmHg, and the median 6-minute walk distance (6-MWD) was 427.5 (300-570) m. The changes in rSO2 measurements ranged between 3.41 and 21.8%, and 70% of the patients had a greater than 10% decrease in rSO2 during the test compared with baseline. Eight patients showed a decrease in rSO2 without SpO2 changes. The present study demonstrated a significant decrease in cerebral oxygenation in pediatric patients with PAH during the 6-MWT. We hypothesized that using a combination of the 6-MWT and regional cerebral oxygenation monitoring in pediatric patients with PAH in order to evaluate exercise capacity, as a reflection of reduced daily activities, would provide more precise predictive values than the 6-MWT alone.

Predictors and Association With Clinical Outcomes of the Changes in Exercise Capacity After Transcatheter Aortic Valve Replacement.

At present, there are no objective data specifically examining the clinical impact of variations in exercise capacity post-transcatheter aortic valve replacement (TAVR). We describe the changes in exercise capacity between baseline and 6 months post-TAVR, and ascertain factors associated with and clinical implications of a lack of improvement in exercise capacity post-TAVR. A total of 305 patients (mean age, 79±9 years; 44% men; Society of Thoracic Surgeons predicted risk mortality score, 6.7±4.2%) undergoing TAVR completed both baseline and follow-up exercise capacity assessments at 6 months post-TAVR. Exercise capacity was evaluated by the 6-minute walk test (6MWT). Clinical outcomes were compared between patients displaying greater than (n=152; improving group) versus less than (n=153; nonimproving group) the median percentage change in distance walked between baseline and 6-month follow-up examinations. The primary outcome measure was clinical event rates, measured from the 6-month post-TAVR period onward. Further dichotomization according to baseline 6MWT distance (less than versus more than median walking distance, or slow walker versus fast walker) was also assessed. The mean overall distances walked pre- and post-TAVR (6 months post-TAVR) were 204±119 and 263±116 m, respectively (Δ6MWT=60±106 m), with 219 (72%) patients demonstrating an increase in their walking distance (median percentage increase of the entire population was 20% [interquartile range, 0%-80%]). Factors independently correlated with reduced exercise capacity improvement included a range of baseline clinical characteristics (older age, female sex, chronic obstructive pulmonary disease; P<0.05 for all), periprocedural major or life-threatening bleeding (P=0.009) and new-onset anemia at 6 months post-TAVR (P=0.009). Failure to improve the 6MWT distance by at least 20% was independently associated with all-cause mortality (P=0.002) and cardiovascular death or rehospitalization for cardiovascular causes (P=0.001). Baseline slow walkers who were able to improve the 6MWT distance presented with significantly better outcomes than nonimprovers (P=0.01 for all-cause mortality; P=0.001 for cardiovascular end point). Approximately one-third of patients undergoing TAVR did not improve their exercise capacity postprocedure. The lack of functional improvement post-TAVR was predicted by a mix of baseline and periprocedural factors translating into poorer clinical outcomes. These results suggest that systematically implementing exercise capacity assessment pre- and post-TAVR may help to improve patient risk stratification.

Reversibility of nerve root sedimentation sign in lumbar spinal stenosis patients after decompression surgery.

The nerve root sedimentation sign (SedSign) is a magnetic resonance imaging (MRI) sign for the diagnosis of lumbar spinal stenosis (LSS). It is included in the assessment of LSS to help determine whether decompression surgery is indicated. Assessment of the reversibility of the SedSign after surgery may also have clinical implications for the decision about whether or not a secondary operation or revision is needed. This study investigated if lumbar decompression leads to a reversal of the SedSign in patients with LSS and a positive SedSign pre-operatively; and if a reversal is associated with more favourable clinical outcomes. If reversal of the SedSign is usual after sufficient decompression surgery, a new positive SedSign could be used as an indicator of new stenosis in previously operated patients. A prospective cohort study of 30 LSS patients with a positive pre-operative SedSign undergoing decompression surgery with or without instrumented fusion was undertaken to assess the presence of nerve root sedimentation (=negative SedSign) on MRI at 3months post-operation. Functional limitation (Oswestry Disability Index, ODI), back and leg pain (Visual Analogue Scale, VAS), and treadmill walking distance were also compared pre- and 3months post-operatively. The short follow-up period was chosen to exclude adjacent segment disease and the potential influence of surgical technique on clinical outcomes at longer follow-up times. 30 patients [median age 73years (interquartile range (IQR) 65-79), 16 males] showed a median pre-operative ODI of 66 (IQR 52-78), a median VAS of 8 (IQR 7-9), and a median walking distance of 0m (IQR 0-100). Three months post-operation 27 patients had a negative SedSign. In this group, we found improved clinical outcomes at follow-up: median post-operative ODI of 21 (IQR 12-26), median VAS of 2 (IQR 2-4), and median walking distance of 1000m (IQR 500-1000). These changes were all statistically significant (p<0.001). Three patients had a positive SedSign at 3-month follow-up due to epidural fat (n=2) or a dural cyst following an intra-operative dural tear (n=1), but also showed improvements in clinical outcomes for ODI, VAS and walking distance. The reversibility of a pre-operative positive SedSign was demonstrated after decompression of the affected segmental level and associated with an improved clinical outcome. A persisting positive SedSign could be the result of incomplete decompression or surgical complications. A new positive SedSign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients.

Transcutaneous Electrical Nerve Stimulation Improves Walking Performance in Patients With Intermittent Claudication.

The purpose of this study was to investigate the effects of 2 types of transcutaneous electrical nerve stimulation (TENS) on walking distance and measures of pain in patients with peripheral arterial disease (PAD) and intermittent claudication (IC). In a phase 2a study, 40 participants with PAD and IC completed a graded treadmill test on 2 separate testing occasions. Active TENS was applied to the lower limb on the first occasion; and placebo TENS, on the second. The participants were divided into 2 experimental groups. One group received high-frequency TENS; and the other, low-frequency TENS. Measures taken were initial claudication distance, functional claudication distance, and absolute claudication distance. The McGill Pain Questionnaire (MPQ) vocabulary was completed at the end of the intervention, and the MPQ-Pain Rating Index score was calculated. Four participants were excluded from the final analysis because of noncompletion of the experimental procedure. Median walking distance increased with high-frequency TENS for all measures (P < .05, Wilcoxon signed rank test, all measures). Only absolute claudication distance increased significantly with low-frequency TENS compared with placebo (median, 179-228; Ws = 39; z = 2.025; P = .043; r = 0.48). No difference was observed between reported median MPQ-Pain Rating Index scores: 21.5 with placebo TENS and 21.5 with active TENS (P = .41). Transcutaneous electrical nerve stimulation applied to the lower limb of the patients with PAD and IC was associated with increased walking distance on a treadmill but not with any reduction in pain. Transcutaneous electrical nerve stimulation may be a useful adjunctive intervention to help increase walking performance in patients with IC.

Padma 28 for intermittent claudication.

Intermittent claudication (IC) is pain caused by chronic occlusive arterial disease that develops in a limb during exercise and is relieved with rest. Most drug treatments of IC have a limited effect in improving walking distance. Padma 28, a Tibetan herbal preparation, has been used to treat IC, but there is debate as to whether Padma 28 produces a clinical benefit beyond the placebo effect. This is an update of a review first published in 2013. To determine whether Padma 28 is effective, compared with placebo or other medications, in increasing pain-free and maximum walking distance for patients with intermittent claudication. For this update the Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (September 2015), the Cochrane Register of Studies ((CENTRAL) (2015, Issue 8)) and clinical trials databases. Randomised controlled trials of Padma 28 compared with placebo or other pharmacological treatments in people suffering from IC. All review authors independently assessed the selected studies and extracted the data. Risk of bias was evaluated independently by two review authors. Depending on the data provided in the individual trials, we extracted mean or median walking distance at the end of the trial, or change in walking distance over the course of the trial, or both. Where not provided, and whenever possible, the statistical significance of differences in these parameters between treatment and placebo groups in individual trials was calculated. Where possible, data were combined by meta-analysis. No new trials were identified in the search for this review update. In total five trials involving 365 participants were included in this review. All trials compared Padma 28 with placebo for at least 16 weeks of follow-up. Pain-free and maximum walking distances both increased significantly in the groups treated with Padma 28, with no significant change in the placebo group. In general, the studies presented results comparing the treatment arms before and after treatment but made no comparisons between the Padma 28 and placebo groups. Pooled data of maximum walking distance after treatment with Padma 28 and placebo from two studies (193 participants) indicated a higher maximum walking distance (mean difference (MD) 95.97 m, 95% confidence interval (CI) 79.07 m to 112.88 m, P < 0.00001, very low quality evidence) in the Padma 28 group compared with placebo. The clinical importance of these observed changes in walking distance is unclear as no quality of life data were reported. There was no effect on ankle brachial index (ABI): change in ABI values between baseline and six months follow up MD -0.01, 95% CI -0.07 to 0.05, 1 study, 56 participants, P = 0.72, very low quality evidence). Mild side effects, especially gastrointestinal discomfort, tiredness and skin eruption, were reported but this outcome was not different between the Padma 28 and placebo groups (odds ratio 1.09, 95% CI 0.42 to 2.83, four studies, 231 participants, P = 0.86, very low quality evidence). Some evidence exists from individual trials to suggest that Padma 28 may be effective in increasing walking distances, at least in the short term (four months), in people with IC. Side effects do not appear to be a problem. However, the longer term effects of treatment are unknown and the clinical significance of the improvements in walking distance are questionable. Moreover, the quality of the evidence is limited by the small sample size of the available trials, limited reporting of statistical analyses that compared treatment groups, and relatively high withdrawal rates that were linked to the outcome. That is, patients were withdrawn if they failed to improve walking distance. There was also evidence of publication bias. We therefore feel there is currently insufficient evidence to draw conclusions regards the effectiveness of Padma 28 in the routine management of IC. Further well-designed research would be required to determine the true effects of this herbal preparation.

0157: Echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction: role of mitral regurgitation

Patients with heart failure and similar left ventricular systolic dysfunction have differing exercise capacity. The aim of this study was to identify echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction. We included 150 patients with class II (70%) or III (30%) heart failure with left ventricular ejection fraction below 40%. Six-minute walking test and cardiac color Doppler-echo, including tissue Doppler of mitral and tricuspid rings, were performed. Moderate and severe mitral regurgitation were considered as significant. Two groups were divided according to the median walking distance (290m): Group 1 <290m and Group 2 >290m. Mitral regurgitation was detected in 112 patients (75%), which was significant in 40 (27%).Group 1 showed more significant mitral regurgitation (35 vs 18%), increased left atrium area (27±1 vs 24±1cm 2 ), mitral E amplitude (88±65 vs 72±3 cm/s) and systolic pulmonary pressure (37±1 vs 32±1 mmHg, all P<.05). By logistic regression analysis, only the presence of significant mitral regurgitation was independently associated with less walked distance (odds ratio: 3.44 95% confidence interval 1.02-11.66, P<.05). By multiple linear regression, the only independent predictor of walked distance was left atrium area (r=0.25, beta coefficient: _6.52±2, P<.01). In patients with class II-III heart failure and left ventricular systolic dysfunction, the main echocardiographic predictors of exercise capacity are related to the presence of significant mitral regurgitation.

Six minute walk test but not functional class predicts outcome in adult patients with Eisenmenger syndrome

Objectives: We assessed the prognostic value of 6-minute-walk-test (6MWT) in adult patients with Eisenmenger syndrome (ES). Background: ES represents the extreme manifestation of pulmonary arterial hypertension in patients with congenital heart disease, associated with significant exercise intolerance and mortality. Even though 6MWT is routinely used in these patients, little is known about its prognostic value in comparison to functional class. Methods and results: We included 210 adult patients with ES (age 37.1±12.9 years, 141 female, 37% in WHO functional class >II) who underwent a total of 822 6MWTs. Median walking distance (6MWD) was 330m [IQR 260-395], oxygen saturation (SO2) at baseline 86% [IQR 82-91%] and SO2 at peak-exercise 69% [IQR 60-80%]. During a follow up of 3.3 years, 29 patients died. On time-dependent Cox analysis, 6MWD (HR 0.94 per 10m, 95% CI: 0.91-0.97, p<0.001) and baseline SO2 (HR 0.90, 95% CI:0.86-0.94, p<0.0001) were predictors of death. In contrast, age, functional class, peak-exercise SO2, SO2 change and Borg score were not related to mortality. On bivariate Cox analysis, both 6MWD and baseline SO2 remained significant predictors of death. A three-fold increased risk of death was identified in patients with baseline SO2 below 85% or not reaching a 6MWD of 350m. Conclusions: The 6MWT is an invaluable objective tool for assessing functional capacity and risk stratifying patients with ES. In contrast, functional class was not predictive of outcome in this contemporary ES cohort and, thus, cannot be solely relied upon for managing these patients.

Six-minute walk test distance and resting oxygen saturations but not functional class predict outcome in adult patients with Eisenmenger syndrome

BackgroundEisenmenger syndrome (ES) represents the extreme manifestation of pulmonary arterial hypertension in patients with congenital heart disease, associated with significant exercise intolerance and mortality. Even though of six-minute-walk-test (6MWT) is routinely used in these patients, little is known about its prognostic value in comparison to functional class. Methods and resultsWe included 210 adult patients with ES who underwent a total of 822 6MWTs. Median walking distance (6MWD) was 330m [IQR 260–395], oxygen saturation (SO2) at baseline 86% [IQR 82–91%] and SO2 at peak-exercise 69% [IQR 60–80%]. In patients commenced on advanced therapy for pulmonary hypertension, but not in the reminder, there was a significant improvement in walking distance (297±97m vs. 325±87m,P=0.0019), SO2 at rest (84.9±7.1 vs. 86.8±5.9%,P=0.003), SO2 at peak exercise (69.1±12.7 vs. 72.3±12.2%,P=0.04) and NYHA functional class (P=0.0047).During a follow up of 3.3years, 29 patients died. On time-dependent Cox analysis, 6MWD (HR 0.94 per 10m, 95%CI: 0.91–0.97,P<0.001) and baseline SO2 (HR 0.90, 95%CI:0.86–0.94,P<0.0001) were predictors of death. In contrast, age, functional class, peak-exercise SO2 and SO2 change were not related to mortality. A three-fold increased risk of death was identified in patients not reaching a 6MWD of 350m or with baseline SO2 below 85%. ConclusionsThe 6MWD and resting SO2, but not functional class were predictive of outcome in this contemporary cohort of Eisenmenger patients and should be incorporated in both risk stratification and management algorithms for these patients.

Gait performance in relation to aortic pulse wave velocity, carotid artery elasticity and peripheral perfusion in healthy older adults

Arterial stiffening is a widely known physiological change that occurs with ageing, but the functional consequences of vascular ageing are unclear. The purpose of this study was to determine whether carotid-femoral pulse wave velocity (PWV), mechanical properties of the carotid and femoral arteries and/or peripheral perfusion was associated with gait performance measured using a 400-m walk test. Twenty-one healthy older (68 ± 5 years) adults without cardiovascular disease participated in this study. Applanation tonometry was used to measure PWV, and Doppler ultrasound was used to measure arterial wall properties of the left common carotid and common femoral artery along with femoral blood flow. The median walk distance in the first 2 min of the test was 585 ft, and the overall gait speed was 1·5 m s(-1). Gait performance was inversely correlated with PWV (distance: r = -0·51; speed: r = -0·48; P<0·05) and carotid artery stiffness index β (distance: r = -0·56; speed: r = -0·51; P<0·05) after adjustment for age, body mass index, waist circumference and systolic blood pressure. No significant correlations were found between gait performance and femoral artery stiffness index β or femoral artery blood flow. These results found higher central arterial stiffness, as assessed by segmental arterial stiffness or local arterial wall properties, is associated with lower gait performance in older adults independent of other confounders.

225 Protective Effect of Anti-High-Mobility Group Box-1 (HMGB1) Antibody on Pulmonary Ischemia-Reperfusion Injury (IRI) in Miniature Swine

measurements were done twice, before and one year after the lung transplantation. The measurements used were spirometry, Vital Capacity (VC) and Forced Expiratory Volyme in one second (FEV&1&), working capacity and 6-Minute Walk Test (6MWT). Health related quality of life was evaluated from the questionnaire Short Form 36 (SF-36). The SF -36 scores range from 0 to 100 with higher scores representing better health related quality of life. Results: 64 of the patients were transplanted during the study period and have done their one year follow-up. Pretransplant results showed that the median VC was 55 % of predicted values and the median FEV&1& was 27 % of predicted values before the lung transplantation and VC 76 % and FEV& 1 & 63 % one year after the operation. The median walking distance of the 6MWT was 240 m before the lung transplantation and 450 m one year after. The median result of the working capacity was 39 % of predicted values before the operation and 58 % one year after. The median value of physical health of SF-36 was 25 before the lung transplantation and 48 one year after and mental health 50 before and 56 after. Conclusions: This study has shown that the lung transplanted patients’ physical capacity and health related quality of life improved significantly one year after lung transplantation.