Correlation between 6-minute walk test distance and New York Heart Association class in stable heart failure patients with ejection fraction ≤ 35%

Eren Gürsoy; Tamer Sayın; Çetin Erol

doi:10.66235/kumj.1901676

Correlation between 6-minute walk test distance and New York Heart Association class in stable heart failure patients with ejection fraction ≤ 35%

Abstract

Aims: The 6-Minute Walk Test is a submaximal exercise test used to assess functional capacity. The New York Heart Association Functional Classification is a key tool for evaluating heart failure severity but relies on subjective assessments, such as patient history and physical examination. The 6-minute Walk Test may provide a more objective measure to support the New York Heart Association Classification. This study investigates the correlation between 6-Minute Walk Test distance and New York Heart Association Class in stable heart failure patients with an ejection fraction ≤ 35%.

Methods: Our study included stable heart failure patients with an ejection fraction of ≤ 35% who were admitted to the Cardiology Outpatient Clinic at Ankara University Faculty of Medicine. We investigated the correlation between the 6-Minute Walk Test distance and the New York Heart Association Functional Class in this patient population. Additionally, we compared the demographic and clinical characteristics of the groups.

Results: A total of 47 patients (mean age: 59.8 ± 12.4 years, 25.5% female) were included in the study. Among them, 8.5% were classified as Functional Class I, 34.0% as Class II, and 57.4% as Class III according to the New York Heart Association Classification. A moderate negative correlation was observed between the 6-Minute Walk Test distance and New York Heart Association Functional Class (r = -0.67). Additionally, a weak negative correlation was found between the 6-Minute Walk Test distance and age (r = -0.37). Patients receiving mineralocorticoid receptor antagonists walked longer distances during the 6-Minute Walk Test. No adverse events were observed during the test.

Conclusion: The 6-Minute Walk Test is a semi-objective, simple, cost-effective, practical and reliable diagnostic tool. It serves as a valuable complementary method that supports traditional subjective assessments, such as anamnesis and physical examination, in determining the New York Heart Association Functional Class.

Keywords

Ethical Statement

Ethical approval for the study was obtained from the Non-Interventional Research Ethics Committee of Ankara University Date: 24.07.2014.

References

1. Authors/Task Force Members:, McDonagh TA, Metra M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2024;26(1):5-17. doi:10.1002/ejhf.3024
2. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117. doi:10.1164/ajrccm.166.1.at1102.
3. Bae SS, Markovic D, Saygin D, et al. Associations between 6-minute walk distance and physiologic measures and clinical outcomes in myositis-associated interstitial lung disease. Rheumatology (Oxford). 2024;keae477. doi:10.1093/rheumatology/keae477.
4. Francis AR, Sugrue TJ, Dennis AT. Pregnancy reference intervals and exertion and breathlessness ratings for the six minute walk test in healthy nulliparous people. Heliyon. 2024;10(4):e25863. doi:10.1016/j.heliyon.2024.e25863.
5. Cavero-Redondo I, Saz-Lara A, Bizzozero-Peroni B, et al. Accuracy of the 6-minute walk test for assessing functional capacity in patients with heart failure with preserved ejection fraction and other chronic cardiac pathologies: results of the ExIC-FEp trial and a meta-analysis. Sports Med Open. 2024;10(1):74. doi:10.1186/s40798-024-00740-6.
6. Sulla-Torres J, Vidal-Espinoza R, Avendaño-Llanque C, et al. Reference values for the 6-min walking test in children and adolescents living in a moderate altitude region of Peru. BMC Pediatr. 2024;24(1):141. doi:10.1186/s12887-023-04459-3.
7. Haass M, Zugck C, Kübler W. Der 6-Minuten-Gehtest: Eine kostengünstige Alternative zur Spiroergometrie bei Patienten mit chronischer Herzinsuffizienz? [The 6 minute walking test: a cost-effective alternative to spiro-ergometry in patients with chronic heart failure?]. Z Kardiol. 2000;89(2):72-80. doi:10.1007/s003920050012.
8. Shah MR, Hasselblad V, Gheorghiade M, et al. Prognostic usefulness of the six-minute walk in patients with advanced congestive heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol. 2001;88(9):987–993. doi:10.1016/s0002-9149(01)01975-0.

9. Ingle L. Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure. Eur J Heart Fail. 2008;10(2):112-118. doi:10.1016/j.ejheart.2007.12.011.
10. Beatty AL, Schiller NB, Whooley MA. Six-minute walk test as a prognostic tool in stable coronary heart disease: data from the heart and soul study. Arch Intern Med. 2012;172(14):1096-1102. doi:10.1001/archinternmed.2012.2198.
11. Ioannou A, Fumagalli C, Razvi Y, et al. Prognostic value of a 6-minute walk test in patients with transthyretin cardiac amyloidosis. J Am Coll Cardiol. 2024;84(1):43–58. doi:10.1016/j.jacc.2024.04.011.
12. Giannitsi S, Bougiakli M, Bechlioulis A, Kotsia A, Michalis LK, Naka KK. 6-minute walking test: a useful tool in the management of heart failure patients. Ther Adv Cardiovasc Dis. 2019;13:1753944719870084. doi:10.1177/1753944719870084.
13. Roul G, Germain P, Bareiss P. Does the 6-minute walk test predict the prognosis in patients with NYHA class II or III chronic heart failure?. Am Heart J. 1998;136(3):449-457. doi:10.1016/s0002-8703(98)70219-4.
14. Andrassy KM. Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'. Kidney Int. 2013;84(3):622–623. doi:10.1038/ki.2013.243.
15. Myers J, Zaheer N, Quaglietti S, et al. Association of functional and health status measures in heart failure. J Card Fail. 2006;12(6):439–445. doi:10.1016/j.cardfail.2006.04.004.
16. Hamilton DM, Haennel RG. Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. J Cardiopulm Rehabil. 2000;20(3):156–164. doi:10.1097/00008483-200005000-00003.
17. Boşnak Güçlü M, Inal İnce D, Arıkan H, et al. A comparison of pulmonary function, peripheral and respiratory muscle strength and functional capacity in the heart failure patients with different functional classes. Anatol J Cardiol. 2011;11(2):101–106. doi:10.5152/akd.2011.027.
18. Guyatt GH, Sullivan MJ, Thompson PJ, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132(8):919–923.

Details

Primary Language

English

Subjects

Cardiology

Journal Section

Research Article

Authors

Eren Gürsoy
0000-0001-6498-3892
Türkiye

Tamer Sayın
0000-0003-3716-540X
Türkiye

Çetin Erol
0000-0001-7396-3818
Türkiye

Publication Date

March 12, 2026

Submission Date

July 1, 2025

Acceptance Date

July 13, 2025

Published in Issue

Year 2026 Volume: 6 Number: 1

DOI

https://doi.org/10.66235/kumj.1901676

IZ

https://izlik.org/JA33EL98AN

Cite

RIS / Bibtex

AMA

1.Gürsoy E, Sayın T, Erol Ç. Correlation between 6-minute walk test distance and New York Heart Association class in stable heart failure patients with ejection fraction ≤ 35%. Kastamonu Medical Journal. 2026;6(1):17-24. doi:10.66235/kumj.1901676