Brisk walking can be a maximal effort in heart failure patients: a comparison of cardiopulmonary exercise and 6 min walking test cardiorespiratory data.

Mapelli M; Salvioni E; Paneroni M; Gugliandolo P; Bonomi A; Scalvini S; Raimondo R; Sciomer S; Mattavelli I;
La Rovere MT; Agostoni P;

ESC heart failure [ESC Heart Fail] 2021 Dec 30. Date of Electronic Publication: 2021 Dec 30.

Aims: Cardiopulmonary exercise test (CPET) and 6 min walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self-selected constant load test usually considered a submaximal, and therefore safer, exercise, but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.
Methods and Results: Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath-by-breath measurement of cardiorespiratory parameters. HF patients were grouped according to their CPET peak oxygen uptake (peakV̇O 2 ). One hundred and fifty-five subjects were enrolled, of whom 40 were healthy (59 ± 8 years; male 67%) and 115 were HF patients (69 ± 10 years; male 80%; left ventricular ejection fraction 34.6 ± 12.0%). CPET peakV̇O 2 was 13.5 ± 3.5 mL/kg/min in HF patients and 28.1 ± 7.4 mL/kg/min in healthy subjects (P < 0.001). 6MWT-V̇O 2 was 98 ± 20% of the CPET peakV̇O 2 values in HF patients, while 72 ± 20% in healthy subjects (P < 0.001). 6MWT-V̇O 2 was >110% of CPET peakV̇O 2 in 42% of more severe HF patients (peakV̇O 2  < 12 mL/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O 2 at 6MWT, reported as a percentage of CPET peakV̇O 2 vs. 6MWT V̇O 2 reported as the absolute value, progressively increased as exercise limitation did.
Conclusions: In conclusion, the last minute of 6MWT must be perceived as a maximal or even supramaximal exercise activity in patients with more severe HF. Our findings should influence the safety procedures needed for the 6MWT in HF.