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THE PROGNOSTIC VALUE OF THE INCREMENTAL SHUTTLE WALK TEST IN CHAGAS CARDIOMYOPATHY
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Abstract
Purpose: To verify the value of the Incremental Shuttle Walk Test (ISWT) distance to identify patients
with Chagas cardiomyopathy (ChC) at risk of adverse cardiovascular events.
Methods: Fifty-two patients with ChC (51 ± 6 years) were evaluated by ISWT, echocardiography,
Cardiopulmonary Exercise Testing, and Human Activity Profile (HAP) Questionnaire. Patients were prospectively followed for 44 ± 10 months. The combined endpoint was cardiac death/heart transplant/stroke.
The prognostic value of ISWT was verified by the Cox regression, and the ISWT was adjusted for age, sex,
left ventricular ejection fraction (LVEF), and minute ventilation/carbon dioxide production relationship
(VE/VCO2 slope).
Results: At the final follow-up, 11 patients (21%) had experienced the endpoint event. When adjusted for
age, sex, LVEF, and VE/VCO2 slope, only ISWT distance (HR 0.99, 95% confidence interval (CI): 0.98–0.99;
p ¼ 0.026) and VE/VCO2 slope (HR 0.93, 95% CI: 0.87–0.99; p ¼ 0.044) remained as independent predictors
of adverse cardiovascular events in patients with ChC. The optimal cutoff point for identifying poor prognosis was the ISWT distance less than 440 m (AUC ¼ 0.72). There was a significant difference (p ¼ 0.032)
in the number of events between the groups with low ISWT distance (440 m) and high (>440 m)
ISWT distance.
Conclusions: The ISWT is a valuable tool with potential value in the prognostic evaluation of patients
with ChC.
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