Association of 30-second chair stand test performance with exercise intolerance and hospitalization for symptomatic heart failure in type 2 diabetes and stage B heart failure

Abstract

Background

Exercise intolerance (EI) predicts hospitalization for symptomatic heart failure (HF) in patients with type 2 diabetes mellitus (T2DM); however, cardiopulmonary exercise testing (CPET) is not always feasible in routine practice. The prognostic value of the 30-second chair stand test (CS30), a simple functional assessment correlated with peak oxygen uptake (peakVO₂), remains unclear. We investigated whether the CS30 reflects exercise capacity and predicts hospitalization for symptomatic HF in patients with T2DM and stage B HF.

Methods

A total of 502 outpatients with T2DM and stage B HF were prospectively enrolled. Exercise capacity was assessed using peakVO₂ from CPET and functional performance using CS30. EI was defined as peakVO₂ ≤80% predicted, and abnormal-CS30 as <18 repetitions for males and <16 for females. Participants were followed for the first hospitalization for symptomatic HF. Associations were assessed using multivariable Cox models, and discrimination using the 5-year time-dependent area under the receiver operating characteristic curve (AUC).

Results

The CS30 performance was significantly associated with peakVO₂. Over a median follow-up of 5.1 years, 91 patients were hospitalized for symptomatic HF. Abnormal-CS30 independently predicted hospitalization for symptomatic HF after adjustment for the WATCH-DM score, B-type natriuretic peptide, left ventricular hypertrophy, and atrial fibrillation. Adding the CS30 to resting risk models significantly improved the 5-year AUC, with performance comparable to that of EI.

Conclusions

In patients with T2DM and stage B HF, the CS30 reflected reduced exercise capacity and independently predicted hospitalization for symptomatic HF. Given its simplicity and feasibility, the CS30 may serve as a practical functional marker to complement resting risk models when CPET is unavailable.