Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure

Susanna L. den Boer, Daniël H.K. Flipse, Marijke H. van der Meulen, Ad P.C.M. Backx, Gideon J. du Marchie Sarvaas, Arend D.J. Ten Harkel, Gabriëlle G. van Iperen, Lukas A.J. Rammeloo, Ronald B. Tanke, Willem A. Helbing, Tim Takken, Michiel Dalinghaus

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4–15.1), median time after diagnosis was 3.6 years (IQR 0.6–7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD%). For all patients, mean 6MWD% was 70 ± 21%. Median follow-up was 33 months (IQR 14–50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD% resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD% < 63% had a 2 year transplant-free survival of 73%, in contrast to a transplant-free survival of 92% in patients with a 6MWD% ≥ 63% (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.

Original languageEnglish
Pages (from-to)465-471
Number of pages7
JournalPediatric Cardiology
Volume38
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

Cite this

den Boer, S. L., Flipse, D. H. K., van der Meulen, M. H., Backx, A. P. C. M., du Marchie Sarvaas, G. J., Ten Harkel, A. D. J., ... Dalinghaus, M. (2017). Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure. Pediatric Cardiology, 38(3), 465-471. https://doi.org/10.1007/s00246-016-1536-y
den Boer, Susanna L. ; Flipse, Daniël H.K. ; van der Meulen, Marijke H. ; Backx, Ad P.C.M. ; du Marchie Sarvaas, Gideon J. ; Ten Harkel, Arend D.J. ; van Iperen, Gabriëlle G. ; Rammeloo, Lukas A.J. ; Tanke, Ronald B. ; Helbing, Willem A. ; Takken, Tim ; Dalinghaus, Michiel. / Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure. In: Pediatric Cardiology. 2017 ; Vol. 38, No. 3. pp. 465-471.
@article{3d6ede3bbc7743f18ac3578168e54930,
title = "Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure",
abstract = "Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4–15.1), median time after diagnosis was 3.6 years (IQR 0.6–7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD{\%}). For all patients, mean 6MWD{\%} was 70 ± 21{\%}. Median follow-up was 33 months (IQR 14–50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD{\%} resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD{\%} < 63{\%} had a 2 year transplant-free survival of 73{\%}, in contrast to a transplant-free survival of 92{\%} in patients with a 6MWD{\%} ≥ 63{\%} (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.",
keywords = "6-minute walk test, Dilated cardiomyopathy, Exercise test, Pediatrics, Prognosis",
author = "{den Boer}, {Susanna L.} and Flipse, {Dani{\"e}l H.K.} and {van der Meulen}, {Marijke H.} and Backx, {Ad P.C.M.} and {du Marchie Sarvaas}, {Gideon J.} and {Ten Harkel}, {Arend D.J.} and {van Iperen}, {Gabri{\"e}lle G.} and Rammeloo, {Lukas A.J.} and Tanke, {Ronald B.} and Helbing, {Willem A.} and Tim Takken and Michiel Dalinghaus",
year = "2017",
month = "3",
day = "1",
doi = "10.1007/s00246-016-1536-y",
language = "English",
volume = "38",
pages = "465--471",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",
number = "3",

}

den Boer, SL, Flipse, DHK, van der Meulen, MH, Backx, APCM, du Marchie Sarvaas, GJ, Ten Harkel, ADJ, van Iperen, GG, Rammeloo, LAJ, Tanke, RB, Helbing, WA, Takken, T & Dalinghaus, M 2017, 'Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure' Pediatric Cardiology, vol. 38, no. 3, pp. 465-471. https://doi.org/10.1007/s00246-016-1536-y

Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure. / den Boer, Susanna L.; Flipse, Daniël H.K.; van der Meulen, Marijke H.; Backx, Ad P.C.M.; du Marchie Sarvaas, Gideon J.; Ten Harkel, Arend D.J.; van Iperen, Gabriëlle G.; Rammeloo, Lukas A.J.; Tanke, Ronald B.; Helbing, Willem A.; Takken, Tim; Dalinghaus, Michiel.

In: Pediatric Cardiology, Vol. 38, No. 3, 01.03.2017, p. 465-471.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure

AU - den Boer, Susanna L.

AU - Flipse, Daniël H.K.

AU - van der Meulen, Marijke H.

AU - Backx, Ad P.C.M.

AU - du Marchie Sarvaas, Gideon J.

AU - Ten Harkel, Arend D.J.

AU - van Iperen, Gabriëlle G.

AU - Rammeloo, Lukas A.J.

AU - Tanke, Ronald B.

AU - Helbing, Willem A.

AU - Takken, Tim

AU - Dalinghaus, Michiel

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4–15.1), median time after diagnosis was 3.6 years (IQR 0.6–7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD%). For all patients, mean 6MWD% was 70 ± 21%. Median follow-up was 33 months (IQR 14–50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD% resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD% < 63% had a 2 year transplant-free survival of 73%, in contrast to a transplant-free survival of 92% in patients with a 6MWD% ≥ 63% (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.

AB - Cardiopulmonary exercise testing is an important tool to predict prognosis in children and adults with heart failure. A much less sophisticated exercise test is the 6 min walk test, which has been shown an independent predictor for morbidity and mortality in adults with heart failure. Therefore, we hypothesized that the 6 min walk test could be predictive for outcome in children with dilated cardiomyopathy. We prospectively included 49 children with dilated cardiomyopathy ≥6 years who performed a 6 min walk test. Median age was 11.9 years (interquartile range [IQR] 7.4–15.1), median time after diagnosis was 3.6 years (IQR 0.6–7.4). The 6 min walk distance was transformed to a percentage of predicted, using age- and gender-specific norm values (6MWD%). For all patients, mean 6MWD% was 70 ± 21%. Median follow-up was 33 months (IQR 14–50). Ten patients reached the combined endpoint of death or heart transplantation. Using univariable Cox regression, a higher 6MWD% resulted in a lower risk of death or transplantation (hazard ratio 0.95 per percentage increase, p = 0.006). A receiver operating characteristic curve was generated to define the optimal threshold to identify patients at highest risk for an endpoint. Patients with a 6MWD% < 63% had a 2 year transplant-free survival of 73%, in contrast to a transplant-free survival of 92% in patients with a 6MWD% ≥ 63% (p = 0.003). In children with dilated cardiomyopathy, the 6 min walk test is a simple and feasible tool to identify children with a higher risk of death or heart transplantation.

KW - 6-minute walk test

KW - Dilated cardiomyopathy

KW - Exercise test

KW - Pediatrics

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=85000963089&partnerID=8YFLogxK

U2 - 10.1007/s00246-016-1536-y

DO - 10.1007/s00246-016-1536-y

M3 - Article

VL - 38

SP - 465

EP - 471

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

IS - 3

ER -

den Boer SL, Flipse DHK, van der Meulen MH, Backx APCM, du Marchie Sarvaas GJ, Ten Harkel ADJ et al. Six-Minute Walk Test as a Predictor for Outcome in Children with Dilated Cardiomyopathy and Chronic Stable Heart Failure. Pediatric Cardiology. 2017 Mar 1;38(3):465-471. https://doi.org/10.1007/s00246-016-1536-y