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Multicenter Study
. 2020 Feb;41(2):223-229.
doi: 10.1007/s00246-019-02244-7. Epub 2019 Nov 12.

Does Repeated Measurement of a 6-Min Walk Test Contribute to Risk Prediction in Children with Dilated Cardiomyopathy?

Marijke H van der Meulen  1 , Susanna den Boer  1 , Gideon J du Marchie Sarvaas  2 , Nico A Blom  3   4 , Arend D J Ten Harkel  3 , Hans M P J Breur  5 , Lukas A J Rammeloo  6 , Ronald Tanke  7 , Willem A Helbing  1   7 , Eric Boersma  8 , Michiel Dalinghaus  9   10
Affiliations
Multicenter Study

Does Repeated Measurement of a 6-Min Walk Test Contribute to Risk Prediction in Children with Dilated Cardiomyopathy?

Marijke H van der Meulen et al. Pediatr Cardiol. 2020 Feb.

Abstract

A single 6-min walk test (6MWT) can be used to identify children with dilated cardiomyopathy (DCM) with a high risk of death or heart transplantation. To determine if repeated 6MWT has added value in addition to a single 6MWT in predicting death or heart transplantation in children with DCM. Prospective multicenter cohort study including ambulatory DCM patients ≥ 6 years. A 6MWT was performed 1 to 4 times per year. The distance walked was expressed as percentage of predicted (6MWD%). We compared the temporal evolution of 6MWD% in patients with and without the study endpoint (SE: all-cause death or heart transplantation), using a linear mixed effects model. In 57 patients, we obtained a median of 4 (IQR 2-6) 6MWTs per patient during a median of 3.0 years of observation (IQR 1.5-5.1). Fourteen patients reached a SE (3 deaths, 11 heart transplantations). At any time during follow-up, the average estimate of 6MWD% was significantly lower in patients with a SE compared to patients without a SE. In both patients groups, 6MWD% remained constant over time. An absolute 1% lower 6MWD% was associated with an 11% higher risk (hazard) of the SE (HR 0.90, 95% CI 0.86-0.95 p < 0.001). Children with DCM who died or underwent heart transplantation had systematically reduced 6MWD%. The performance of all patients was stable over time, so repeated measurement of 6MWT within this time frame had little added value over a single test.

Keywords: 6MWT; Dilated cardiomyopathy; Heart failure; Pediatric cardiology; Risk factors.

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Conflict of interest statement

Author MH van der Meulen declares that she has no conflict of interest. All other authors declare that they have has no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of eligible patients and included patients
Fig. 2
Fig. 2
Transplant-free survival curves of DCM patients with 6MWD ≤ 63% of predicted compared to patients with 6MWD > 63% of predicted
Fig. 3
Fig. 3
Serial measurement of 6MWD expressed as percentage of predicted, time before study endpoint. The average estimates of the longitudinal trajectory of 6MWD%: the black line indicates the patients without a study endpoint, the red line the patients with a study endpoint. The dashed lines depict the 95% confidence interval
Fig. 4
Fig. 4
Serial measurement of 6MWD expressed as percentage of predicted, time since diagnosis. The average estimates of the longitudinal trajectory of 6MWD%: the black line indicates the patients without a study endpoint, the red line the patients with a study endpoint. The dashed lines depict the 95% confidence interval
Fig. 5
Fig. 5
Serial measurement of 6MWD expressed as percentage of predicted, time before study endpoint. The average estimates of the longitudinal trajectory of 6MWD%: the black line indicates the patients without a study endpoint, the red line the patients with a study endpoint. The dashed lines depict the 95% confidence interval. The individual patients are plotted, the colored lines indicate the patients with the study endpoint
See this image and copyright information in PMC

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