Department of Cardiology, Fondazione "Salvatore Maugeri", IRCCS, Montescano (Pavia), Italy
Department of Biomedical Engineering, Fondazione "Salvatore Maugeri", IRCCS, Montescano (Pavia), Italy.
Eur J Prev Cardiol. 2015 Jan;22(1):20-6. doi: 10.1177/2047487313502405. Epub 2013 Aug 22.
The 6-minute walking test (6mWT) is used to prescribe physical activity in cardiac surgery patients. The clinical value of a pre-discharge 6mWT and its association with outcome is not well defined.
We retrospectively analyzed data from 313 patients (age 66 ± 11 years, 23% females, left ventricular ejection fraction (LVEF) 52 ± 11%, Hb 10.5 ± 1.3 g/dl, serum albumin 3.9 ± 0.4 mg/dl) who were admitted to our rehabilitation institute following cardiac surgery. A 6mWT was performed at entry and at discharge and expressed as % of theoretical predicted values calculated on the basis of individual age, height, weight and sex. The endpoint was represented by all-cause mortality. The predictive value of 6mWT was tested in univariate and multivariate analysis.
A pre-discharge 6mWT was completed by 284 out of 313 patients. Two patients died in hospital. During a median of 23 months, mortality was 9% (26/284) and 44% (12/27) (p < 0.0001) in patients who did or did not perform the pre-discharge 6mWT. The distance covered at the pre-discharge 6mWT as a continuous variable of % predicted values was a significant predictor of subsequent mortality (Hazard Ratio (HR) 0.97 (95% CI 0.96-0.99), p = 0.0019). After adjustment for all preselected covariates, the pre-discharge 6mWT (HR 0.97 (95% CI 0.95-0.99), p = 0.0038) and LVEF (HR 0.93 (95% CI 0.90-0.96), p < 0.0001) remained significantly associated with the outcome.
In recent cardiac surgery patients, the pre-discharge 6mWT is not only a valid measurement of the impact of cardiac rehabilitation but also provides outcome information offering the possibility to identify patients who may need more intensive follow-up.
6 分钟步行测试（6mWT）用于为心脏手术患者开出体力活动处方。出院前 6mWT 的临床价值及其与结果的关联尚不清楚。
我们回顾性分析了 313 名（年龄 66±11 岁，23%为女性，左心室射血分数（LVEF）52±11%，Hb 10.5±1.3g/dl，血清白蛋白 3.9±0.4mg/dl）接受心脏手术后入住我们康复研究所的患者的数据。在入院时和出院时进行了 6mWT 检查，并表示为根据个人年龄、身高、体重和性别计算的理论预测值的百分比。终点为全因死亡率。6mWT 的预测价值在单变量和多变量分析中进行了测试。
313 名患者中有 284 名完成了出院前 6mWT。2 名患者在医院死亡。在中位数为 23 个月的时间里，未进行和进行出院前 6mWT 的患者死亡率分别为 9%（26/284）和 44%（12/27）（p<0.0001）。出院前 6mWT 时的距离作为预测值的连续变量是随后死亡率的显著预测因素（危险比（HR）0.97（95%CI 0.96-0.99），p=0.0019）。在校正所有预先选择的协变量后，出院前 6mWT（HR 0.97（95%CI 0.95-0.99），p=0.0038）和 LVEF（HR 0.93（95%CI 0.90-0.96），p<0.0001）仍然与结果显著相关。
在最近接受心脏手术的患者中，出院前 6mWT 不仅是心脏康复影响的有效测量，还提供了预后信息，有可能识别出需要更强化随访的患者。
