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Results:The 6-MWT distance correlated with t-IVT and Tei index (r=-0.37, p<0.001, for both), lateral and septal e’ velocities (r=0.41, p<0.001, and r=0.46, p<0.001, respectively), E/e’ ratio (r=-0.37, p<0.001) and TAPSE (r=0.45, p<0.001), but not with the other clinical or echo parameters. Group I patients had longer t-IVT, lower E/e’ratio, TAPSE and lateral e’ (p<0.001 for all) compared with Group II. In multivariate analysis, TAPSE [0.076 (0.017-0.335), p=0.001], E/e’ [1.165 (1.017-1.334), p=0.027], t-IVT [1.178 (1.014-1.370), p=0.033] independently predicted poor 6-MWT performance (<300 m). Sensitivity and specificity for TAPSE 1.9 cm were 66% and 77%, (AUC 0.78, p<0.001); E/e’ 10.7 were 66% and 62% (AUC 0.67, p=0.002) and t-IVT 13 s/min were 64% and 60% (AUC 0.68, p=0.002) in predicting poor 6-MWT. Combined TAPSE and E/e’ had a sensitivity of 68% but specificity of 92% in predicting 6-MWT. Respective values for combined TAPSE and t-IVT were 71% and 85%. Conclusion:In patients with HF, the limited exercise capacity assessed by 6-MWT, is multifactorial being related to severity of right ventricular systolic dysfunction as well as raised LV filling pressures and global dyssynchrony.

Right ventricular dysfunction predict limited exercise capacity in heart failure with reduced ejection fraction