ABC Heart Fail Cardiomyop 2025; 5(2): 20240063

Determinants of the Six-Minute Walk Distance in Subjects with Heart Failure-Chronic Obstructive Pulmonary Disease Overlap

Maria Luísa Dadalt , Isadora Farraco Correa , Fernanda Lais Loro , Marlus Karsten , Mariane Borba Monteiro , Pedro Dal Lago

DOI: 10.36660/abchf.20240063i

Abstract

Background

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist in clinical practice, with both conditions negatively affecting individuals’ functional capacity, often measured using the 6-minute walk test (6MWT). Cardiovascular, pulmonary, and metabolic impairments may influence the 6-minute walk distance (6MWD).

Objective

This study aims to identify and analyze the critical determinants of the 6MWD among subjects with HF-COPD overlap.

Methods

A cross-sectional study was conducted. Individuals underwent the 6MWT. Respiratory muscle strength was assessed by measuring maximum inspiratory pressure and maximum expiratory pressure. Pulmonary function was evaluated using forced expiratory volume in the first second (FEV₁) and forced vital capacity (FVC). Physical frailty was assessed using the Cardiovascular Health Study frailty index. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, and cognitive function was assessed using the Montreal Cognitive Assessment.

Results

Thirty-two individuals were evaluated, with a mean age of 67.6 ± 8.5 years; 65.6% were women. The mean left ventricular ejection fraction was 54.7 ± 15.9%, and the mean 6MWD was 281 ± 102 meters. The 6MWD was significantly correlated with FVC (r = 0.61, p < 0.01); percentage of predicted FEV₁ (r = 0.58, p < 0.01); percentage of predicted FVC (r = 0.56, p < 0.01); Cardiovascular Health Study frailty index (r = 0.53, p < 0.01); and Minnesota Living with Heart Failure Questionnaire score (r = −0.47, p < 0.01). Gait speed (β = −0.54, p < 0.001); FEV₁ (β = −0.44, p < 0.001); and New York Heart Association functional class (β = −0.24, p < 0.001) were identified as significant predictors of 6MWD.

Conclusions

These findings suggest that an integral approach, incorporating both physical and psychosocial assessments, may be essential for effectively managing functional limitations in patients with HF-COPD. Identifying these predictors can aid clinicians in tailoring treatment strategies, optimizing rehabilitation programs, and improving this population’s overall quality of care.