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Functional testing: comparing the results of 6-minute walk test with handgrip and postural tests

Session Poster session 3

Speaker Simona Poznic

Event : Heart Failure 2017

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : B Leskovar (Trbovlje,SI), T Furlan (Trbovlje,SI), S Poznic (Trbovlje,SI), B Kljucevsek (Trbovlje,SI), A Adamlje (Trbovlje,SI)

Authors:
B Leskovar1 , T Furlan1 , S Poznic1 , B Kljucevsek2 , A Adamlje1 , 1Trbovlje General Hospital, Department of Internal Medicine - Trbovlje - Slovenia , 2Trbovlje General Hospital, Department of Hemodialyisis - Trbovlje - Slovenia ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 493

Introduction. 6-minute walk test (6MWT) is most widely used for testing functional capacity of heart failure patients. Some patients can’t perform it well or at all due to other non-cardiac comorbidities.
Purpose. We wanted to test the correlation of 6MWT with other functional tests (handgrip test, postural tests).
Methods. We performed 6MWT in 30 hemodialysis patients. They performed the test three times in the same setting (before hemodialysis). Handgrip test was performed before hemodialysis three times in three different positions (standing-up, sitting, lying down) using both arms. Postural testing was performed before hemodialysis using the postural test protocol (balance tests, gait speed, chair stand test). Positional influence on handgrip test results was tested with one-way repeated measures ANOVA and functional tests correlation with Pearson’s correlation coefficient. We also tested the influence of AVF on handgrip test results (multiple linear regression). In 22 patients with concurrent end-stage kidney disease and heart failure we evaluated possible correlations between echocardiographic parameters, biomarkers and functional tests (multiple linear regression).
Results. Thirty patients (60% male, mean age 64.4±13.3 years, mean ITM 27.1±4.6 kg/m2) performed the 6MWT (mean 65±18% of predicted distance), handgrip test (right arm 23±10kg; left arm 22±10kg), postural tests (10±3 points (of 12 maximum)). Handgrip results were not influenced by body position (right: F(2.0,56.5)=0.395, p=0.67; left:  F(1.4,40.7)=1.573, p=0.22)), neither by the presence of an AVF (right: F(2,27)=2.268, p=0.123, R2=0.144; left: F(2,27)=0.991, p=0.384, R2=0.068). All functional tests had a statistically significant positive correlation with each other. In 22 hemodialysis patients with heart failure (50% men, mean age 65.5±11.7 years, mean NT-proBNP 1425±1226 pg/ml, mean LVEF 57.1±13.0%, 45% with HFrEF), high troponin was the most important prognostic factor of lower LVEF, lower VTI and higher E/A. NT-proBNP was a statistically significant prognostic factor of lower Em and higher E/Em. None of the tested laboratory or echocardiographic parameters were associated with hospitalization rate due to heart failure in the last two years or the results of functional tests. Low VTI was a prognostic factor of longer hospital stay due to heart failure in the last two years.
Conclusion(s). 6MWT can be replaced with other functional tests (handgrip test, postural test) to evaluate functional capacity. This is particularly useful in elderly disabled patients, where 6MWT results are often influenced by their disability to walk for 6 minutes continuously. In addition, handgrip test is not influenced by body position or presence of AVF. In patients with concurrent end-stage kidney disease and heart failure, troponin T was a better prognostic factor of chronic heart failure and none of echocardiographic or laboratory parameters were associated with the results of functional tests.

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