Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy (Drs Vitale, Mandalà, and Sarullo); Faculty of Medicine, University of Palermo, Palermo, Italy (Ms Sarullo and Dr Vassallo); Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York (Dr Franco); Division of Cardiology, V. Fazzi Hospital, Lecce, Italy (Dr Marazia); Cardiothoracic Division, Istituto Mediterraneo per i Trapianti e le Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (Dr Raffa); and Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, Federico II University of Naples, Naples, Italy (Dr Giallauria).
J Cardiopulm Rehabil Prev. 2018 Sep;38(5):304-308. doi: 10.1097/HCR.0000000000000340.
This single-center retrospective analysis aimed to evaluate the prognostic relevance of 6-min walk test (6MWT) in patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery.
One hundred one patients able to perform a 6MWT within the first week of admission (time after surgery: 16 ± 8 d) were included (age 68 ± 11 y; 55% female; median left ventricular ejection fraction 55% [interquartile range: 50-60]; 51% after aortic valve surgery). Study endpoints were cardiovascular death and the combined outcome of cardiovascular death/cardiac hospitalization. Univariate and multivariate analyses were performed to analyze predictive value of the 6MWT.
After a median follow-up of 27 mo, cardiovascular mortality was 9.9% while combined endpoint occurrence was 33%. Patients experiencing study endpoints had lower left ventricular ejection fraction, higher N-terminal prohormone of brain natriuretic peptide serum levels, and longer in-hospital stay (all P < .05). The 6MWT distance was a significant predictor of cardiovascular death (hazard ratio [HR] = 0.89, 95% CI: 0.81-0.97, P = .007) and cardiac hospitalizations (HR = 0.95, 95% CI: 0.90-0.99, P = .02). Even after adjusting for the relevant confounding variables of cardiovascular death and cardiac hospitalization, the adjusted HR = 0.88, 95% CI: 0.75-0.98, P = .028 and adjusted HR = 0.95, 95% CI: 0.90-0.99, P = .05, respectively.
In patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery, 6MWT proved to be an independent prognostic tool, potentially allowing identification of high-risk patients for whom a more intensive and tailored in-hospital cardiovascular rehabilitation program should be designed and implemented in order to avoid unfavorable cardiovascular events.
本单中心回顾性分析旨在评估 6 分钟步行试验（6MWT）在接受心脏直视手术后住院心血管康复计划中的患者的预后相关性。
共纳入 101 例可在入院后第一周内完成 6MWT 的患者（术后时间：16±8 天）（年龄 68±11 岁；55%为女性；中位数左心室射血分数为 55%[四分位间距：50-60%]；51%为主动脉瓣手术后）。研究终点为心血管死亡和心血管死亡/心脏住院的联合结局。进行单变量和多变量分析以分析 6MWT 的预测价值。
中位随访 27 个月后，心血管死亡率为 9.9%，而联合终点发生率为 33%。发生研究终点的患者左心室射血分数较低，N 末端脑钠肽前体血清水平较高，住院时间较长（均 P<0.05）。6MWT 距离是心血管死亡（危险比[HR] = 0.89，95%置信区间：0.81-0.97，P = 0.007）和心脏住院（HR = 0.95，95%置信区间：0.90-0.99，P = 0.02）的显著预测因素。即使在校正了心血管死亡和心脏住院的相关混杂变量后，调整后的 HR = 0.88，95%置信区间：0.75-0.98，P = 0.028 和调整后的 HR = 0.95，95%置信区间：0.90-0.99，P = 0.05。
在接受心脏直视手术后住院心血管康复计划的患者中，6MWT 被证明是一种独立的预后工具，可能能够识别高危患者，应为其设计和实施更强化和量身定制的住院心血管康复计划，以避免不良心血管事件。
