An Assessment of Cardiovascular Functional Capacity of a Group of Chronic Heart Failure Patients Using the 6-Minute Walk Test in a Cameroonian Urban Setting

Background: Chronic heart failure is a public health problem worldwide. It has a high mortality rate and is accompanied by a decreased functional capacity and alteration of the quality of life. Objective: This study aimed to assess the cardiovascular functional capacity of a group of patients suffering from heart failure using the 6-minute walk test (6 MWT). Methods: This was a cross-sectional study carried out in the cardiology unit of Douala’s general hospital for 4 months. We included all eligible patients aged 18 years or more who had stable chronic heart failure and gave informed consent. Those who had an acute coronary syndrome (≤1 month), tachycardia (HR ≥ 120 bpm), high blood pressure (SBP ≥ 180 mmHg and/or DBP ≥ 100 mmHg) and reduced mobility due to orthopaedic reasons were excluded. A 6 MWT was done according to the American Thoracic Society guidelines. The 6 MWT result was considered poor for - 450 m and good for >450 m. Results: We recruited a total of 81 patients (61.7% women) with a mean age of 65.9 ± 10.6 years. The most frequent risk factor for heart failure was high blood pressure (77.8%), alcohol consumption(69.1%) and a sedentary lifestyle (53.1%). The left ventricular ejection fraction was mostly preserved (42.0%) or mildly altered (46.9). The 6 MWT results were poor in 55.6% of cases, average in 19.8% of cases and good in only 24.7% of cases. More than half (59.3%) of the participants perceived the effort as being difficult. The cardiovascular functional capacity was significantly associated with age, heart failure stage and physical activity (p Conclusion: Most patients suffering from chronic stable heart failure in the general hospital of Douala have poor cardiovascular functional capacity.

Effects of 6-minute walk test on the QT dispersion in patients with congestive heart failure

Objective: To investigate the clinical value of QT dispersion (QTd) and the effects of 6-minute walk test (6-MWT) mimicking the patients' daily activities on QTd in patients with congestive heart failure (CHF).Methods: Twenty-eight CHF patients and 22 normal subjects participated these study, who all completed 6-MWT without developing severe arrhythmias.Before and after 6-MWT, standardized 12-lead surface ECGs were obtained to measure QTd and corrected QTd (QTcd).Results: Both before and after 6-MWT, the QTd and QTcd in CHF patients were longer than those in the controls (P<0.001), and QTd and QTcd after 6-MWT were significantly shorter than those before 6-MWT in CHF patients (P=0.007, and 0.018).There was no significant difference in the measurement in the control group.Conclusion: QTd and QTcd are longer in CHF patients than in normal subjects.Moderate exercise may improve the inhomogeneity of ventricular repolarization dispersion in CHF patients.

Six-Minute Walk Test in Patients with Rheumatoid Arthritis

Background: The 6-minute walk test (6TC) was initially used as an instrument for assessing physical and cardiorespiratory capacity, but is currently being used to monitor treatments, and compare physical interventions and prognostic evaluation. Although already recognized as a research method in several specialties, 6TC has not been used in rheumatology. Patients with rheumatoid arthritis (RA) may have impaired functional capacity as well as increased cardiovascular mortality. An adequate functional evaluation of these patients is necessary and the 6TC may be useful in this sense. Objective: The aim of this study was to perform the 6-minute walk test in RA patients and to compare the performance with a control group. Method: A cross-sectional study was carried out in which the sample consisted of 85 women, 46 patients with rheumatoid arthritis and 39 healthy controls. A descriptive analysis of the data was performed. One-Way ANOVA methodology was used to compare the patient and control groups followed by the graphic analysis. Results: The distance walked on the 6TC by RA patients was on average 522.2 meters. In the distance control group found in the 6TC was on average 628.8 meters, the difference being statistically significant. Conclusion: In this study the distance covered in 6TC by women with RA was lower than that of healthy women of the same age.

Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities

Background The relationship between the 6-minute walk test （6MWT） and pulmonary function test in stable chronic obstructive pulmonary disease （COPD） remains unclear. We evaluate the correlation of 6MWT and spirometric parameters in stable COPD with different severities. 6MWT data assessed included three variables： the 6-minute walk distance （6MWD）, 6-minute walk work （6MWORK）, and pulse oxygen desaturation rate （SPO2%）. Methods 6MWT and pulmonary function test were assessed for 150 stable COPD patients with different severities. Means and standard deviations were calculated for the variables of interest. Analysis of variance was performed to compare means. Correlation coefficients were calculated for 6MWT data with the spirometric parameters and dyspnea Borg scale. Multiple stepwise regression analysis was used to screen pulmonary function-related predictors of 6MWT data. Results The three variables of 6MWT all varied as the severities of the disease. The 6MWD and 6MWORK both correlated with some spirometric parameters （positive or negative correlation; the absolute value of r ranging from 0.34 to 0.67; P 〈0.05） in severe and very severe patients, and the SPO2% correlated with the dyspnea Borg scale in four severities （t= -0.33, -0.34, -0.39, -0.53 respectively; P 〈0.05）. The 6MWD was correlated with the 6MWORK in four severities （r=0.56, 0.57, 0.72, 0.81 respectively, P 〈0.05）, and neither of them correlated with the SPO2%. The percent of predicted forced expiratory volume in 1 second （FEV1% predicted） and residual volume to total lung capacity ratio （RV/TLC） were predictors of the 6MWD, and the maximum voluntary ventilation （MW） was the predictor of the 6MWORK. Conclusions 6MWT correlated with the spirometric parameters in severe and very severe COPD patients. 6MWT may be used to monitor changes of pulmonary function in these patients.

院内+居家续贯式心脏康复模式在急性心肌梗死急诊冠状动脉介入治疗术后患者中的应用效果研究

背景目前,国际与国内Ⅱ期门诊心脏康复的参与率偏低,国外研究显示以家庭为基础的心脏康复临床获益等同于医院门诊心脏康复,且可靠安全,但居家心脏康复在我国的研究较少。目的探讨院内+居家续贯式心脏康复模式在急性心肌梗死急诊冠状动脉介入治疗术(PCI)后患者心脏康复中的应用效果。方法选取2018年6月—2019年2月在首都医科大学大兴教学医院心内科住院且行急诊PCI的急性心肌梗死患者80例作为研究对象。按随机数字表法将研究对象分为观察组(n=40)和对照组(n=40),观察组采用院内+居家续贯式心脏康复模式干预3个月,对照组给予常规干预3个月。比较两组患者入院时及干预3个月后的体质指数(BMI)、血压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、6 min步行距离、左室射血分数(LVEF)、吸烟情况。并根据出院前6 min步行试验结果将观察组和对照组患者细分为6 min步行距离≥400 m组和<400 m组,进一步比较两组干预前后6 min步行距离。结果两组入院时血压、TC、LDL-C、LVEF、BMI比较,差异无统计学意义(P>0.05),两组出院前6 min步行距离比较,差异无统计学意义(P>0.05)。观察组干预3个月后收缩压、舒张压、TC、LDL-C、BMI低于干预前,6 min步行距离高于干预前,差异有统计学意义(P<0.05);对照组干预3个月后TC、BMI低于干预前,6 min步行距离高于干预前,差异有统计学意义(P<0.05)。干预3个月后观察组TC、LDL-C低于对照组,6 min步行距离长于对照组,差异有统计学意义(P<0.05)。观察组TC、LDL-C、BMI及6 min步行距离干预前后差值高于对照组,差异有统计学意义(P<0.05)。观察组干预后3个月后戒烟率为70.6%(24/34),对照组戒烟率为39.4%(13/33),两组戒烟率比较,差异有统计学意义(P=0.010)。6 min步行距离≥400 m组观察组和对照组出院时、干预后3个月6 min步行距离比较,差异无统计学意义(P>0.05);两组干预3个月后6 min步行距离均较出院时增加,差异有统计学意义(P<0.05)。6 min步行距离<400 m观察组和对照组干预3个月后6 min步行距离均较出院时增加,差异有统计学意义(P<0.05);干预3个月后观察组6 min步行距离高于对照组,差异有统计学意义(P<0.05)。结论院内+居家续贯式心脏康复模式利于急性心肌梗死急诊PCI后患者控制危险因素(血压、血脂、吸烟、BMI)、改变行为方式、改善日常体力活动能力(尤其对于6 min步行距离<400 m组)。

Effect of Tongxinluo Capsule on Patients with Syndrome X and Affective Disorder

Background: To explore the therapeutic effect of Tongxinluo capsule (Tongxinluo) on patients with Syndrome X and Affective Disorder. Methods: Fifty-six patients with Syndrome X and Affective Disorder were randomly divided into a Tongxinluo capsule group and a placebo control group. The duration of treatment was 12 weeks. A 6-minute walking test, exercise load electrocardiogram and clinical symptom assessment were performed before and after treatment. After 12 weeks of treatment, the scores of the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were repeated. The levels of serum endothelin-1 (ET-1) and nitric oxide (NO) were measured before and after treatment. Results: Compared with the placebo control group, the Tongxinluo group SAS and SDS scores were lower than those before treatment (all P < 0.01), and the 6-minute walking distance increased significantly (P < 0.01). Clinical symptoms were significantly improved. The exercise test results suggested that, while improved, there was no significant difference (P > 0.05) when compared to before treatment. In the Tongxinluo treatment group, the levels of plasma endothelin-1 decreased significantly (P < 0.01) and nitric oxide levels were significantly increased (P < 0.01), with a significant difference when compared to the control group (P Conclusions: The Tongxinluo capsule can improve the Affective Disorder of Syndrome X, reduce the degree of anxiety and depression, increase exercise tolerance, reduce clinical symptoms, and improve vascular endothelial function.

Meta-analysis on Efficacy of Yiqi Huoxue Chinese Drugs in the Treatment of Coronary Heart Disease after Coronary Revascularization

[Objectives] To make a systematic evaluation on the therapeutic efficacy and safety of Yiqi Huoxue traditional Chinese drugs combined with western medicine in treatment of coronary heart disease( CHD) after coronary revascularization. [Methods] The literatures were retrieved from China Knowledge Infrastructure( CNKI),Chinese science and technology journal full-text database( VIP database,VIP),Wanfang Data,the Chinese biomedical Database,Pub Med,Embase,and the Cochrane Library. The retrieval time was set to the creation of the database to January 2017. The randomized controlled trial( RCT) was conducted on the comparison between Yiqi Huoxue Chinese drugs combined with western medicine and the western medicine alone in the treatment of CHD after coronary revascularization. The literature information was extracted and the methodological quality of the included literature was evaluated according to the bias risk assessment tool developed by the Cochrane Collaboration. Meta-analysis was performed with the aid of Rev Man 5. 3 software. Coronary artery restenosis rate,angina pectoris treatment efficiency,left ventricular ejection fraction( LVEF),left ventricular end-diastolic volume( LVEDV),B-type natriuretic peptide( BNP),6-minute walk test( 6 MWT),and adverse reactions were analyzed. [Results] A total of 29 articles were included,a total of2 518 patients,the literature quality was low. Meta-analysis results showed that compared with the treatment by western medicine alone,Yiqi Huoxue Chinese drugs combined with western medicine could further reduce coronary restenosis rate[RR = 0. 45,95% CI( 0. 34,0. 60),P <0. 000 01],improve the angina pectoris treatment efficiency[RR = 1. 13,95% CI( 1. 05,1. 21),P = 0. 000 5],raise LVEF[WMD = 4. 25,95% CI( 3. 46,5. 04),P < 0. 000 01],reduce LVEDV[WMD =-10. 41,95% CI(-17. 88,-2. 95),P = 0. 006],decrease the plasma BNP level[WMD =-32. 32,95% CI(-44. 92,-19. 72),P < 0. 000 01],and increase 6 MWT distance(WMD = 62. 25,95% CI( 21. 71,102. 78),P = 0. 003)[Conclusions]Yiqi Huoxue Chinese drugs combined with western medicine can alleviate the symptoms of angina pectoris,reduce the rate of coronary restenosis,improve heart function and improve exercise capacity,thereby improving clinical efficacy in patients with CHD after coronary revascularization.

Normative Values of Cardio-Respiratory Endurance in Adults in Benin

Cardiorespiratory endurance is a determining factor in the assessment of the state of health of a person. Objective: To determine the reference values for cardiorespiratory endurance in Beninese adults. Methods: Prospective transversal study, with a descriptive and analytical aim. It was carried out on healthy adult subjects (18 to 50 years old), of Cotonou and Abomey cities, from October 2017 to May 2018, without clinically identifiable orthopedic, cardiorespiratory, osteoarticular or neuromotor impairment. These subjects performed three different cardio-respiratory endurance tests: The six-minute walk test (WT6), cycloergometer test (CT) and the step test (ST). Data processing and analysis were done using SPSS version 22 software. A linear regression model was used to establish the prediction equation of maximal oxygen uptake (VO2 max) with the WT6 data. The significance level chosen was 5%. Results: Subjects average age was 30.0 ± 9.8 years. It was especially men (54.20%), students (42.13%), with a normal corpulence (69.91%). At WT6, they walked 365 m to 798 m (557.1 ± 93.6 m) with extreme heart rates (EHR) of 67 to 189 (136.7 ± 19.0) beats per minute. At ST, the extreme powers developed were 2.7 watts/kg and 11.8 watts/kg (6.4 ± 1.8 watts/kg), with EHR of 99 to 204 (168.4 ± 15.4) beats per minute. The predictor equation of VO2 max by WT6 was function of the subject’s weight, age and sex (R = 0.73). Conclusion- Discussion: These normative values of cardio-respiratory endurance of Beninese subjects seem to be specific to them. An extension of the present study to a larger sample nevertheless seems desirable.

Long-term Efficacy of Pulmonary Artery Desnervation Treatment in Heart Failure With Preserved Ejection Fraction:A Subgroup Analysis of 3-year Results From the PADN-5 Study

Objective:The Pulmonary Arterial Denervation in Patients With Pulmonary Hypertension Associated With the Left Heart Failure(PADN-5)study proved that pulmonary artery denervation(PADN)is associated with significant improvements in hemodynamic and clinical outcomes in patients with combined pre-and post-capillary pulmonary hypertension(CpcPH).This study aimed to assess the 3-year clinical results of PADN in patients who had heart failure with preserved ejection fraction(HFpEF)developing into CpcPH(HFpEF-CpcPH).Methods:In this post hoc analysis of the PADN-5 trial,38 patients with HFpEF were included in screening out of 98 patients with CpcPH who were randomly assigned to treatment with sildenafil and sham PADN(sham PADN(plus sildenafil)group,abbreviated as sham group)or PADN(PADN group).HFpEF in the PADN-5 trial was defined as a left ventricular ejection fraction≥50%,and CpcPH was defined as a mean pulmonary arterial pressure≥25 mmHg,a pulmonary arterial wedge pressure>15 mmHg,and a pulmonary vascular resistance>3.0 WU.The changes in the 6-minute walk distance(6-MWD)and the plasma concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)at 6-month and 3-year follow-up,as well as the clinical endpoint of the occurrence of clinical worsening,defined as cardiopulmonary-related death,rehospitalization,or heart or lung transplantation at 3-year follow-up were examined.Results:Thirty-eight patients with HFpEF-CpcPH were assigned to the PADN group(n=19)or the sham group(n=19).At the 6-month follow-up,6-MWD(433(275,580)m vs.342(161,552)m),and reductions in NT-proBNP(−47%(−99%,331%)vs.−12%(−82%,54%))were significantly improved in the PADN group(all P<0.05).Over the 3-year follow-up period,PADN treatment resulted in marked increases in 6-MWD(450(186,510)m vs.348(135,435)m)and reductions in NT-proBNP(−55%(−99%,38%)vs.−10%(−80%,95%))(all P<0.05).Clinical worsening was experienced by 12 patients(63%)in the sham group,but by only 5 patients(26%)in the PADN group(hazard ratio=0.149,95%confidence interval:0.038–0.584,P=0.006).The 6-MWD and PADN treatments were independent predictors of clinical deterioration in patients with HFpEF-CpcPH.Conclusions:PADN therapy is associated with improvements in exercise capacity and clinical outcomes.PADN therapy may have a potential role in patients with HFpEF-CpcPH for whom current treatment options are limited.

冠状动脉介入治疗对急性心肌梗死患者心功能的影响

目的探究冠状动脉介入治疗对急性心肌梗死患者心功能的影响。方法选取2020年7月-2023年6月我院收治的86例急性心肌梗死患者,根据不同治疗方式分成对照组和观察组,每组各43例。对照组接受常规治疗,观察组接受冠状动脉介入,对比两组治疗前后心功能指标[左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、左心室射血分数(LVEF)]、6 min步行试验(6-minute walk test,6MWT)以及心脏不良事件发生率。结果治疗前,两组心功能标对比(P>0.05),治疗4周后,观察组LVEDVI、LVESVI下降较对照组明显,LVEF提升较对照组明显,具有显著差异(P<0.05);治疗1周后,两组6MWT对比无统计学意义(P>0.05),治疗2周、治疗4周后,两组6MWT逐渐提升,观察组较对照组提升明显,具有统计学意义(P<0.05);两组心脏不良事件发生率对比,观察组更低(P<0.05)。结论急性心肌梗死患者行冠状动脉介入治疗,能改善患者心功能,提高患者6MWT距,改善运动耐力,对于心脏不良事件发生率的降低有积极作用。

Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure（s SVCP）, mean superior vena cava pressure（m SVCP）, and left pulmonary artery systolic pressure（s LPAP） were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg（P = 0.025）,s RPAP ≤ 22 mm Hg（P = 0.0001, mRPAP ≤ 13 mm Hg（P =0.003）, s LPAP ≤ 27 mm Hg（P =0.03）, m LPAP ≤ 11 mm Hg（P = 0.01）, PVR ≤ 4.3 Wood U/m^2（P 〈0.0001） and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg（P = 0.06） and s PVR ≤ 2.0 wood U/m^2（P = 0.0531）. One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m^2 can help identify post Glenn-shunt patients indicated for TCPC.