Averaged Oxygen Desaturation Improves the Prognostic Value of the Six-Minute Walk Test in Elderly Patients with Heart Failure.

IF 4.1 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of physiology. Heart and circulatory physiology Pub Date : 2024-11-08 DOI:10.1152/ajpheart.00578.2024

Isamu Sunayama, Kyung-Duk Min, Yoshiyuki Orihara, Junichi Ono, Yuki Matsumoto, Aika Daimon, Yuko Soyama, Eri Manabe, Makiko Oboshi, Kohei Azuma, Masataka Sugahara, Akiyo Eguchi, Yoshiro Naito, Shinichiro Suna, Masanori Asakura, Masaharu Ishihara

{"title":"Averaged Oxygen Desaturation Improves the Prognostic Value of the Six-Minute Walk Test in Elderly Patients with Heart Failure.","authors":"Isamu Sunayama, Kyung-Duk Min, Yoshiyuki Orihara, Junichi Ono, Yuki Matsumoto, Aika Daimon, Yuko Soyama, Eri Manabe, Makiko Oboshi, Kohei Azuma, Masataka Sugahara, Akiyo Eguchi, Yoshiro Naito, Shinichiro Suna, Masanori Asakura, Masaharu Ishihara","doi":"10.1152/ajpheart.00578.2024","DOIUrl":null,"url":null,"abstract":"Background: Heart failure (HF) is a major cause of hospitalization, and exercise capacity is a key prognostic marker. The six-minute walk test (6MWT) is widely used to assess exercise capacity, but six-minute walk distance (6MWD) varies among individuals, especially the elderly.Aim: This study aimed to assess the hypothesis that ΔSpO₂-Ex, the average oxygen desaturation during the 6MWT, could enhance the prognostic value of 6MWD in elderly HF patients for cardiovascular risk prediction.Methods: In this single-center, prospective observational study, 55 patients aged ≥ 65 years with acute HF were evaluated before discharge. Patients were divided into small and large ΔSpO₂-Ex groups and short and long 6MWD groups based on cut-off values of 6.7% and 220 m, respectively, obtained from the Receiver Operating Characteristics curve analysis. Patients were followed for one year to assess major adverse cardiovascular events, including rehospitalization for heart failure or cardiovascular death.Results: The mean ΔSpO₂-Ex was 5.8 ± 4.3%, and the mean 6MWD was 237.5 ± 106.7 m. Patients with large ΔSpO₂-Ex had significantly higher event rates (HR 6.66, p < 0.001), while those with short 6MWD had HR of 2.40 (p = 0.03). Combining ΔSpO₂-Ex with 6MWD improved predictive accuracy (AUC 0.78) compared to either marker alone (AUC 0.72 for ΔSpO₂-Ex and 0.62 for 6MWD). Importantly, patients with both large ΔSpO₂-Ex and short 6MWD had the highest event rates, indicating the additive prognostic value of combining both markers.Conclusion: ΔSpO₂-Ex is a complementary marker to 6MWD, improving risk stratification in elderly HF patients.","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":""},"PeriodicalIF":4.1000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of physiology. Heart and circulatory physiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1152/ajpheart.00578.2024","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Heart failure (HF) is a major cause of hospitalization, and exercise capacity is a key prognostic marker. The six-minute walk test (6MWT) is widely used to assess exercise capacity, but six-minute walk distance (6MWD) varies among individuals, especially the elderly.

Aim: This study aimed to assess the hypothesis that ΔSpO₂-Ex, the average oxygen desaturation during the 6MWT, could enhance the prognostic value of 6MWD in elderly HF patients for cardiovascular risk prediction.

Methods: In this single-center, prospective observational study, 55 patients aged ≥ 65 years with acute HF were evaluated before discharge. Patients were divided into small and large ΔSpO₂-Ex groups and short and long 6MWD groups based on cut-off values of 6.7% and 220 m, respectively, obtained from the Receiver Operating Characteristics curve analysis. Patients were followed for one year to assess major adverse cardiovascular events, including rehospitalization for heart failure or cardiovascular death.

Results: The mean ΔSpO₂-Ex was 5.8 ± 4.3%, and the mean 6MWD was 237.5 ± 106.7 m. Patients with large ΔSpO₂-Ex had significantly higher event rates (HR 6.66, p < 0.001), while those with short 6MWD had HR of 2.40 (p = 0.03). Combining ΔSpO₂-Ex with 6MWD improved predictive accuracy (AUC 0.78) compared to either marker alone (AUC 0.72 for ΔSpO₂-Ex and 0.62 for 6MWD). Importantly, patients with both large ΔSpO₂-Ex and short 6MWD had the highest event rates, indicating the additive prognostic value of combining both markers.

Conclusion: ΔSpO₂-Ex is a complementary marker to 6MWD, improving risk stratification in elderly HF patients.

查看原文本刊更多论文

平均血氧饱和度可提高六分钟步行测试对老年心力衰竭患者的预后价值

背景：心力衰竭（HF）是住院治疗的主要原因，而运动能力是预后的关键指标。六分钟步行测试（6MWT）被广泛用于评估运动能力，但六分钟步行距离（6MWD）因人而异，尤其是老年人。目的：本研究旨在评估一个假设，即ΔSpO₂-Ex（六分钟步行测试期间的平均血氧饱和度）可提高六分钟步行距离对老年心力衰竭患者心血管风险预测的预后价值：在这项单中心前瞻性观察研究中，55 名年龄≥ 65 岁的急性心房颤动患者在出院前接受了评估。根据Receiver Operating Characteristics曲线分析得出的6.7%和220米的临界值，将患者分为小ΔSpO₂-Ex组和大ΔSpO₂-Ex组，以及短6MWD组和长6MWD组。对患者进行为期一年的随访，以评估主要心血管不良事件，包括心衰再住院或心血管死亡：ΔSpO₂-Ex平均值为5.8 ± 4.3%，6MWD平均值为237.5 ± 106.7 m。将ΔSpO₂-Ex 与 6MWD 结合使用可提高预测准确性（AUC 0.78），而单独使用其中一个指标则无法提高预测准确性（ΔSpO₂-Ex 的 AUC 为 0.72，6MWD 为 0.62）。结论：ΔSpO₂-Ex 是 6MWD 的补充指标，可改善老年 HF 患者的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American journal of physiology. Heart and circulatory physiology 医学-生理学

CiteScore

9.60

自引率

10.40%

发文量

202

审稿时长

2-4 weeks

期刊介绍： The American Journal of Physiology-Heart and Circulatory Physiology publishes original investigations, reviews and perspectives on the physiology of the heart, vasculature, and lymphatics. These articles include experimental and theoretical studies of cardiovascular function at all levels of organization ranging from the intact and integrative animal and organ function to the cellular, subcellular, and molecular levels. The journal embraces new descriptions of these functions and their control systems, as well as their basis in biochemistry, biophysics, genetics, and cell biology. Preference is given to research that provides significant new mechanistic physiological insights that determine the performance of the normal and abnormal heart and circulation.