Incremental shuttle walk test in the assessment of patients for heart transplantation

  • Lewis M
  • Newall C
  • Townend J
 et al. 
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Abstract

Objective - To compare the incremental shuttle walk test (ISWT) with treadmill exercise testing (TT) derived measurement of peak oxygen consumption (peak Vo2) in patients undergoing assessment for cardiac transplantation. Design - Prospective comparison. All investigations occurred during a single period of admission for transplant assessment. Setting - Single UK cardiothoracic transplantation unit. Patients - 25 patients recruited (21 men). Mean age was 53 years. Interventions - Patients underwent two TT of peak Vo2 using the modified Naughton protocol and three (one practice) ISWT. Investigations were performed on consecutive days. Main outcome measures - Main outcome measures were repeatability of TT and ISWT assessments; relation between peak Vo2 and distance walked in the ISWT; and receiver operating characteristic (ROC) analysis to establish a distance walked in the ISWT that predicted which patients would have a peak Vo2 greater than 14 ml/min/kg. Results - Both the ISWT and the TT were highly reproducible. Following the first practice walk, mean (SD) ISWT distances were 400.0 (146)m (ISWT2) and 401.3 (129) m (ISWT3), r = 0.90, p < 0.0001. Mean peak Vo2 by TT was 15.2 (4.4) ml/kg/min (TT1) and 15.0 (4.4) ml/kg/min (TT2), r = 0.83, p < 0.0001. The results revealed a strong correlation between distance covered in the ISWT and peak Vo2 obtained during TT (r = 0.73, p = 0.0001). ROC analysis showed that a distance walked of 450 m allowed the selection of patients with a peak Vo2 of over 14 ml/min/kg. Conclusions - This work confirms the utility of the ISWT in the assessment of exercise capacity in patients with severe heart failure undergoing assessment for cardiac transplantation. ISWT may provide a widely applicable surrogate measure for peak Vo2 estimation in this population. Shuttle distance walked may therefore allow the convenient, serial assessment of patients with heart failure before referral for transplantation.

Author-supplied keywords

  • Cardiac transplantation
  • Incremental shuttle walk
  • Peak oxygen consumption
  • adult
  • article
  • clinical article
  • controlled study
  • exercise test
  • exercise tolerance
  • female
  • functional assessment
  • heart failure/su [Surgery]
  • heart transplantation
  • human
  • male
  • oxygen consumption
  • preoperative evaluation
  • priority journal
  • walking

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Authors

  • M E Lewis

  • C Newall

  • J N Townend

  • S L Hill

  • R S Bonser

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