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PubMed1994

Influence of heterologous tobamovirus movement protein and chimeric-movement protein genes on cell-to-cell and long-distance movement.

Sunn-hemp mosaic tobamovirus (SHMV) moves slowly from cell to cell in Nicotiana tabacum cv. Xanthi, but fails to move long distance. To determine the role of the SHMV movement protein (MP) in cell-to-cell and long-distance movement in tobacco, the SHMV MP gene was inserted into a TMV-cDNA clone that had approximately the 5'-half of the endogenous MP gene deleted. RNA transcripts inoculated onto tobacco induced systemic infections by 8 days postinoculation. Sequence analysis of the MP genes from purified virus isolated from systemically infected leaf tissue indicated that chimeric SHMV/TMV MP genes had been generated through RNA-RNA recombination within the 3'-termini of the MP gene sequences. When exchanged for the MP gene of TMV, three of four chimeric MP genes analyzed provided long-distance movement function for the hybrid viruses in tobacco. Two of the three hybrid viruses that moved long distance showed enhanced cell-to-cell movement relative to a recombinant TMV that expressed the intact SHMV MP gene. These observations suggest that the C-terminus of the TMV MP contains a determinant that can influence cell-to-cell movement in tobacco. A recombinant virus, TLSM, that expressed the intact SHMV MP gene exhibited cell-to-cell movement that was intermediate to SHMV and TMV, but failed to produce coat protein and was defective in long-distance movement. To further examine the role of the SHMV MP gene in long-distance movement, transgenic N. tabacum cv. Xanthi that expressed the wild-type SHMV MP gene were generated and found to facilitate rapid and efficient long-distance movement of a TMV mutant that contained a dysfunctional MP gene. Therefore, the inability of SHMV to systemically infect tobacco is a function of virus components and sequences other than those encoded by the SHMV MP gene.

Base Sequence↗
PubMed1997

Genome amplification and long-distance movement functions associated with the central domain of tobacco etch potyvirus helper component-proteinase.

The tobacco etch potyvirus (TEV) helper component-proteinase (HC-Pro, 460 amino acid residues) is a multifunctional protein involved in aphid-mediated transmission, genome amplification, polyprotein processing, and long-distance movement. To investigate the interrelationships between three of these functions, 25 alanine-scanning mutations affecting clusters of charged residues were introduced into the HC-Pro coding sequence. The resulting mutants were analyzed with respect to HC-Pro proteolytic activity in vitro, genome amplification in protoplasts, and long-distance movement in tobacco plants. Three classes of mutants were identified. Class I mutants (total of 17) were capable of genome amplification, long-distance movement, and HC-Pro proteolysis with efficiencies similar to parental virus. The class III mutant (total of 1) encoded a proteolytically debilitated HC-Pro and was replication-defective. Class II mutants (total of 7) encoded proteolytically active HC-Pro, but each exhibited a suppressed amplification phenotype that was characterized by a progressive shutoff during the course of infection in protoplasts. The class II mutants also exhibited defects in long-distance movement, accumulating to relative levels of 0 to 7.5% in noninoculated tissue. Wild-type HC-Pro supplied in trans was able to partially rescue the class II mutant amplification defects in protoplasts and long-distance movement defects in plants, although the extent of complementation of movement function varied for each mutant. Six of the seven class II mutations affected the central region of HC-Pro between residues 126 and 300, whereas only one affected the C-terminal proteolytic domain. These results indicate that the central region of HC-Pro is necessary for efficient genome amplification and long-distance movement, and that the one or more HC-Pro functions involved in these processes is at least partially trans-active. Additionally, the long-distance movement properties of a previously characterized HC-Pro-defective mutant (TEV-GUS/CCCE) were characterized further using grafted nontransgenic and HC-Pro-expressing transgenic plants. The results indicated that HC-Pro is required in both inoculated and noninoculated tissues to complement the TEV-GUS/CCCE movement defects.

Alanine↗
PubMed1990

Capillarity and diffusion distances in skeletal muscles in birds.

Tissue capillarity and diffusion distances were determined for red and white skeletal muscles of adult birds ranging in mass from 10.8 to 6200 g. In addition, literature values for capillarity and diffusion distances in skeletal muscles of mammals were incorporated into the data set. Muscle mass was closely coupled to body mass. However, no significant allometric relations were found for any of the other variables measured. Number of capillaries per fiber was not correlated with cross sectional area of individual muscle fibers. Thus, capillary density decreased in a hyperbolic manner against fiber area and diffusion distance decreased in a hyperbolic manner against the number of capillaries per muscle fiber. Red muscles had significantly higher numbers of capillaries per fiber and significantly shorter diffusion distances than did white muscles. The patterns for tissue capillarity and diffusion distances in avian muscle reported here are similar to values reported previously for mammalian muscles. In both taxonomic groups capillarity and diffusion distances are independent of body mass. In addition, diffusion distances are characteristic of capillaries distributed in random arrays through the muscle cross section.

Animals↗
PubMed1990

Peak blood ammonia and lactate after submaximal, maximal and supramaximal exercise in sprinters and long-distance runners.

The purpose of this study was to elucidate the difference in peak blood ammonia concentration between sprinters and long-distance runners in submaximal, maximal and supramaximal exercise. Five sprinters and six long-distance runners performed cycle ergometer exercise at 50% maximal, 75% maximal, maximal and supramaximal heart rates. Blood ammonia and lactate were measured at 2.5, 5, 7.5, 10 and 12.5 min after each exercise. Peak blood ammonia concentration at an exercise intensity producing 50% maximal heart rate was found to be significantly higher compared to the basal level in sprinters (P less than 0.01) and in long-distance runners (P less than 0.01). The peak blood ammonia concentration of sprinters was greater in supra-maximal exercise than in maximal exercise (P less than 0.05), while there was no significant difference in long-distance runners. The peak blood ammonia content after supramaximal exercise was higher in sprinters compared with long-distance runners (P less than 0.01). There was a significant relationship between peak blood ammonia and lactate after exercise in sprinters and in long-distance runners. These results suggest that peak blood ammonia concentration after supramaximal exercise may be increased by the recruitment of fast-twitch muscle fibres and/or by anaerobic training, and that the processes of blood ammonia and lactate production during exercise may be strongly linked in sprinters and long-distance runners.

Adolescent↗
PubMed1984

Blood lactate and glycerol after 400-m and 3,000-m runs in sprint and long distance runners.

Lactate, glycerol, and catecholamine in the venous blood after 400-m and 3,000-m runs were determined in eight sprint runners, eight long distance runners, and seven untrained students. In 400-m sprinting, average values of velocity, peak blood lactate, and adrenaline were significantly higher in the sprint group than in the long distance and untrained groups. The mean velocity of 400-m sprinting was significantly correlated with peak blood lactate in the untrained (r = 0.76, P less than 0.05) and long distance (r = 0.71, P less than 0.05) groups, but not in the sprint group. In the 3,000-m run, on the other hand, average values of velocity and glycerol were significantly higher in the long distance group than in the sprint and untrained groups, but there are no significant differences in lactate levels between the three groups. These results suggest that 1) performance in 400-m sprinting may depend mainly upon an energy supply from glycolysis in the long distance and untrained group, but in the sprinters is influenced not only by glycolysis, but also by other factors such as content of ATP or force per unit muscle cross-sectional area; 2) peak blood lactate obtained after 400-m sprinting may be used as a useful indication of anaerobic work capacity in the long distance and untrained groups, but not in the sprinters. 3) high speed in the 3,000-m run could be maintained in the long distance runners by means of a greater energy supply from lipid metabolism as compared with sprinters or untrained subjects.

Adult↗
PubMed2000

The effects of focus-skin distance and shaping block tray on the calibration factor of in-vivo dosimetry diodes.

PURPOSE: In-vivo dose measurements during conformal treatment require correction factor evaluations for differences in block shapes, field size and source-skin distance (SSD). The aim of this paper is to evaluate a single correction factor, CFentranceSSD, depending only on source-skin distance, which takes into account both shape and size of blocked fields, in pelvic treatments. MATERIALS AND METHODS: A set of measurements was performed to investigate the effects of different block shapes and sizes, source-skin distances and collimator settings on the entrance dose values. For this reason EDP 20 Scanditronix diodes, with 20 mm water-equivalent build-up cap, were irradiated by 2 Varian linear accelerators (Clinac 1800 and Clinac 2100) 18 MV photon beams with 3 different collimator settings. Diodes were calibrated by comparison with a Farmer 2571 ionization chamber at reference conditions (10 cm x 10 cm open field, source-skin distance 100 cm, build-up depth 3.3 cm) in order to convert the semiconductor signal into water absorbed dose. Three sets of different measurements (regarding open beams, tray fields and shaped fields) were performed. Diode responses were compared with the ionization chamber ones, in the same irradiation conditions. RESULTS: The CFentranceSSD trends can be described by linear fits in dependence upon source-skin distance, and the effect with tray alone or with tray and blocks is stronger than in the open field. The observed effects can be interpreted by the influences of a) the different source distances of diode and reference point in the phantom and b) the secondary electron contamination of the photon beam upon the calibration factor of the diode. CONCLUSION: The effects of source-skin distance and of the shaping blocks and tray upon the diode calibration factor can be effectively accounted for by a single CFentranceSSD correction factor.

Calibration↗
PubMed2005

Differential influence of vision and proprioception on control of movement distance.

The purpose of this study was to investigate the contribution of proprioceptive and visual information about initial limb position in controlling the distance of rapid, single-joint reaching movements. Using a virtual reality environment, we systematically changed the relationship between actual and visually displayed hand position as subjects' positioned a cursor within a start circle. No visual feedback was given during the movement. Subjects reached two visual targets (115 and 125 degrees elbow angle) from four start locations (90, 95, 100, and 105 degrees elbow angle) under four mismatch conditions (0, 5, 10, or 15 degrees). A 2 x 4 x 4 ANOVA enabled us to ask whether the subjects controlled the movement distance in accord with the virtual, or the actual hand location. Our results indicate that the movement distance was mainly controlled according to the virtual start location. Whereas distance modification was most extensive for the closer target, analysis of acceleration profiles revealed that, regardless of target position, visual information about start location determined the initial peak in tangential hand acceleration. Peak acceleration scaled with peak velocity and movement distance, a phenomenon termed "pulse-height" control. In contrast, proprioceptive information about actual hand location determined the duration of acceleration, which also scaled with peak velocity and movement distance, a phenomenon termed "pulse-width" control. Because pulse-height and pulse-width mechanisms reflect movement planning and sensory-based corrective processes, respectively, our current findings indicate that vision is used primarily for planning movement distance, while proprioception is used primarily for online corrections during rapid, unseen movements toward visual targets.

Adult↗
PubMed2004

Genetic distance in housekeeping genes between Plasmodium falciparum and Plasmodium reichenowi and within P. falciparum.

The time to the most recent common ancestor of the extant populations of Plasmodium falciparum is controversial. The controversy primarily stems from the limited availability of sequences from Plasmodium reichenowi, a chimpanzee malaria parasite closely related to P. falciparum. Since the rate of nucleotide substitution differs in different loci and DNA regions, the estimation of genetic distance between P. falciparum and P. reichenowi should be performed using orthologous sequences that are evolving neutrally. Here, we obtained full-length sequences of two housekeeping genes, sarcoplasmic and endoplasmic reticulum Ca2+ -ATPase (serca) and lactate dehydrogenase (ldh), from 11 isolates of P. falciparum and 1 isolate of P. reichenowi and estimate the interspecific genetic distance (divergence) between the two species and intraspecific genetic distance (polymorphism) within P. falciparum. Interspecific distance and intraspecific distance at synonymous sites of interspecies-conserved regions of serca and ldh were 0.0672 +/- 0.0088 and 0.0011 +/- 0.0007, respectively, using the Nei and Gojobori method. Based on the ratio of interspecific distance to intraspecific distance, the time to the most recent common ancestor of P. falciparum was estimated to be (8.30 +/- 5.40) x 10(4) and (11.62 +/- 7.56) x 10(4) years ago, assuming the divergence time of the two parasite species to be 5 and 7 million years ago, respectively.

Amino Acid Sequence↗
PubMed1988

The distance from the skin to the epidural space.

To determine whether there is any systemic relationship between the distance from the skin to the epidural space and physical constitution, the distance from the skin to the epidural space was measured in 1007 epidural punctures. The distance from the skin to the epidural space in male was greater than that in female ( P << 0.001). However, the analysis of the distance from the skin to the epidural space of the selected patients who had both a weight of 50-60 kg and a height of 1.5-1.7 m indicated no statistical difference between male and female. The best correlation was found between the distance from the skin to the epidural space and body weight. The correlation between the distance from the skin to the epidural space and height was less striking. Ninety-five percent of the patients who received epidural puncture at the thoraco-cervical area (C7-T2) had a distance to the epidural space of 4.0-6.9 cm; 87% at the lower-thoracic area (T8-T10), 4.0-6.9 cm; 93% at the thoraco-lumbar area (T12-L2), 3.0-4.9 cm; 85% at the mid-lumbar area (L2-L4), 3.0-4.9 cm. These results may be useful for young anesthesiologists to master epidural block safely and efficiently.

Journal Article↗
PubMed1984

Scintigraphic determination of ventricular function and coronary perfusion in long-distance runners.

Left ventricular function and coronary perfusion were evaluated with rest-exercise gated blood pool and stress-redistribution thallium scans in a group of long-distance runners and compared to a group of catheterization-proved normal subjects. Exercise duration, work load, and oxygen consumption were significantly greater for long-distance runners. Rest end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volumes (SV) were significantly larger in long-distance runners than in control subjects, while ejection fraction (EF), cardiac index (CI), and ejection rate were similar in both groups. Exercise EDV increased and ESV decreased, producing an increase in SV and EF in long-distance runners. Exercise EDV did not change and ESV decreased less, producing lesser increase in SV and EF in the control group. Qualitative evaluation of thallium scans showed apparent perfusion defects with normal redistribution in six myocardial segments in five long-distance runners. Quantitative evaluation demonstrated initial defects, which persisted on delay scans, but were associated with normal relative redistribution in three ventricular walls in three long-distance runners. In conclusion, left ventricular reserve function was greater in long-distance runners than in control subjects. Endurance exercise can be associated with apparent myocardial perfusion defects, which may be due to uneven ventricular hypertrophy resulting from the pressure and volume loads imposed by exercise.

Adult↗
PubMed1986

Importance of the distance and velocity of electrical forces in the diagnosis of inferior wall healed myocardial infarction: a vectorcardiographic study.

The vectorcardiograms of 41 patients with angiographically proved inferior myocardial infarction (MI) and 51 normal subjects were analyzed to determine whether it is the time (in milliseconds) or the distance (in millivolts) of the initial superiority directed forces of ventricular depolarization that is increased more by inferior MI, and whether parameters derived from both the initial superior time and distance can be used to detect inferior MI. The 10 best individual and the 10 best paired criteria for inferior MI involve superior distance, either alone or used in the calculation of average velocity (in volts per second), and the product of initial superior time and distance (in millivolts per second). The 2 best individual criteria for inferior MI are: inferior velocity more than 0.0065 V/s (sensitivity 71%, specificity 100%) and superior distance more than 0.39 mV (sensitivity 68%, specificity 100%). These diagnostic performances are superior to those of the best criterion that involves only the duration of the initial superior forces, i.e., initial superior time longer than 28 ms (sensitivity 49%, specificity 98%) (chi 2 = 8.42, p less than 0.005 and chi 2 = 6.31, p less than 0.025, respectively). Initial superior distance and parameters calculated from both initial superior distance and time are better vectorcardiographic criteria for inferior MI than are criteria that involve only initial superior time.

Diagnosis, Differential↗
PubMed1992

Measurement of oxygen diffusion distance in tumor cubes using a fluorescent hypoxia probe.

Oxygen diffusion distance was measured in solid tumor "cubes" prepared by excising the tumor from the mouse and incubating 1-2 mm sided tumor cubes in spinner culture flasks with fluorescent drugs (AF-2 or DM113) which bind to hypoxic cells. After incubation, frozen sections were prepared and examined for AF-2 or DM113 binding using a fluorescence image processing system. Alternatively, cubes were stained with a slowly penetrating fluorescent dye, Hoechst 33342, prior to disaggregation and measurement of AF-2 binding using flow cytometry. The distance from the cube surface to the AF-2 stained region (i.e., the thickness of the unstained rim) was used as an indication of oxygen diffusion distance, which depends on the square root of the tumor oxygen consumption rate. Oxygen diffusion distance was dependent on tumor type, external oxygen concentration, and temperature during incubation with AF-2, but was unaffected by tumor size up to 1.2 gm or position of the cube within the tumor. Oxygen diffusion distances (in planar geometry) measured for cubes prepared from SCCVII, RIF-1, Lewis lung or WiDr tumors were 107, 123, 153 and 193 microns, respectively. For SCCVII and WiDr tumors, the percentage of blood vessels separated by a distance greater than double the mean oxygen diffusion distance was used as an indication of the hypoxic fraction.

Animals↗
PubMed2005

Distance measure error induced by displacement of the ulnar nerve when the elbow is flexed.

OBJECTIVES: To determine the presence of ulnar nerve displacement at the elbow when it is flexed and to determine its effect on distance measurements using the conventional measurement method for nerve conduction studies (NCSs). DESIGN: Comparing the ultrasonography-assisted distance measurement method with the conventional measurement method. SETTING: An electrodiagnostic laboratory at a university hospital. PARTICIPANTS: Seventy-eight elbows of 39 healthy volunteers. INTERVENTIONS: We used high-resolution ultrasonography in real time. Based on sonographic searching, we marked 3 points on the skin through the course of the displaced ulnar nerve when the elbow is flexed: (1) point A, 7 cm above the elbow (from the midpoint between the medial epicondyle tip and olecranon in the postcondylar groove [point M]); (2) point B, 3 cm below the elbow; and (3) point C, the point closest to the medial epicondyle tip. MAIN OUTCOME MEASURES: Distance measurements between points A, B, and C were taken. These values were compared with measurements obtained through conventional measurement methods. RESULTS: Ulnar nerve displacement occurred in 24.3% (19/78) of the elbows; approximately 20.5% (16/78) were subluxation, and 3.8% (3/78) were dislocation. In the ulnar nerve displacement group, the distance between points A and C was 5.84+/-0.33 cm (range, 5.10-6.30 cm), and the distance between points B and C in the flexed position was 3.35+/-0.19 cm (range, 3.10-3.70 cm). When the conventional distance measurement was used, the ulnar nerve conduction velocity across the elbow was overestimated by approximately 5.33+/-2.29 m/s in the ulnar nerve displacement group. CONCLUSIONS: This distance measurement error may be responsible for the decreased sensitivity found in NCSs that test for ulnar neuropathy at the elbow. If the NCS results are normal in patients who have clear symptoms of ulnar neuropathy, the possibility of ulnar nerve displacement at the elbow should be considered, and further investigation with ultrasonography would be beneficial.

Adult↗
PubMed2005

Relation between narrowed coracohumeral distance and subscapularis tears.

PURPOSE: To determine whether coracohumeral distance was significantly narrowed in the presence of a torn subscapularis. TYPE OF STUDY: Retrospective cohort study. METHODS: The coracohumeral distance of a consecutive series of patients (n = 35, 36 shoulders) requiring an arthroscopic repair of the subscapularis was compared with a control group (n = 35). The control group consisted of patients who underwent shoulder arthroscopy but who did not have any rotator cuff, subscapularis, or subcoracoid pathology. The coracohumeral distance was measured from the tip of the coracoid to the cortex of the proximal humerus on an axial cut of preoperative magnetic resonance imaging. A Student t test was used to determine the statistical differences between the 2 groups. RESULTS: The average coracohumeral distance in the subscapularis group was 5.0 +/- 1.7 mm and the average coracohumeral distance in the control group was 10.0 +/- 1.3 mm. Statistical analysis, using the Student t test, showed that the coracohumeral distance was significantly narrowed in the group of patients with a torn subscapularis. CONCLUSIONS: These results show a significant relationship between a narrowed coracohumeral distance and subscapularis pathology. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Aged↗
PubMed2006

Measures of arterial stiffness and wave reflection are associated with walking distance in patients with peripheral arterial disease.

We hypothesized that measures of arterial stiffness and wave reflection influence functional capacity of patients with peripheral arterial disease (PAD). Consecutive patients (n=106, 69+/-10 years, 66% men) referred for lower extremity arterial evaluation were studied. Radial artery pulse waveforms were obtained by applanation tonometry and an ascending aortic pressure waveform derived by a transfer function. Aortic augmentation index (AIx) is the difference between the first and second systolic peak of the ascending aortic pressure waveform indexed to the pulse pressure (PP) and T(r) is the reflected wave arrival time. Ankle-brachial index (ABI) and walking distance were measured as per laboratory protocol after excluding patients with non-compressible vessels (ABI>1.5) and severe PAD (ABI<0.5). To account for right-censoring of walking distances in patients completing the 5 min walk (n=56), we used survival analysis to identify variables associated with walking distance. Mean (+/-S.D.) values were: AIx, 31.2+/-10.9%; T(r), 134+/-18 ms; PP, 66.5+/-17.1 mmHg; ABI, 0.87+/-0.22; walking distance, 177+/-75 m. In both multivariable accelerated failure time (AFT) and Cox proportional-hazards models, older age, female sex, greater body mass index, lower ABI, and a measure of arterial stiffness (higher AIx and PP, lower T(r)) were associated with a lower walking distance. Higher AIx and lower T(r) were associated with a lower walking distance even after adjustment for PP as well as in the subset of patients with PAD (ABI<0.9 at rest or post-exercise, n=82). In conclusion, measures of arterial stiffness and wave reflection are associated with walking distance in patients with PAD and may be a target of therapy in such patients.

Aged↗
PubMed2004

Voluntary running distance is negatively correlated with striatal dopamine release in untrained rats.

This study examined the relationship between voluntary running distance and glutamate- and K+-stimulated dopamine release in the striatum (nucleus accumbens and caudate-putamen) of male Long-Evans rats. Twenty-one rats were housed individually in cages with attached running-wheels for 1 week. There was a 19-fold variability between rats in voluntary running distances over this period (range = 2.3-44.6 km). The average distance completed during the week was 16 +/- 2.8 km. There was a strong positive correlation between the running distances completed during the first 24 h (day 1) and the last 24 h. Certain rats were therefore inclined to run from the start. The average daily running distance (2.4 +/- 0.4 km per day) was negatively correlated with the weight of the rat (r = -0.82). Glutamate-stimulated release of dopamine was not a significant predictor of voluntary running distance. However, the average daily running distance was negatively correlated with K+-stimulated dopamine release in the nucleus accumbens core and caudate-putamen but not the nucleus accumbens shell. The present findings suggest that decreased depolarization-induced release of striatal dopamine may be a predictor of hyperactivity. The results show, in a normal population of Long-Evans rats, that there are, at the end of the continuum, rats that display some of the neurochemical and behavioral characteristics of a rat model for attention-deficit hyperactivity disorder.

Analysis of Variance↗
PubMed2006

Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women.

PURPOSE: We sought to study the effect of distance to the nearest radiation treatment facility on the use of postmastectomy radiation therapy (PMRT) in elderly women. METHODS AND MATERIALS: Using data from the linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we analyzed 19,787 women with Stage I or II breast cancer who received mastectomy as definitive surgery during 1991 to 1999. Multivariable logistic regression was used to investigate the association of distance with receipt of PMRT after adjusting for clinical and sociodemographic factors. RESULTS: Overall 2,075 patients (10.5%) treated with mastectomy received PMRT. In addition to cancer and patient characteristics, in our primary analysis, increasing distance to the nearest radiation treatment facility was independently associated with a decreased likelihood of receiving PMRT (OR = 0.996 per additional mile, p = 0.01). Secondary analyses revealed that the decline in PMRT use appeared at distances of more than 25 miles and was statistically significant for those patients living more than 75 miles from the nearest radiation facility (odds of receiving PMRT of 0.58 [95% CI = 0.34-0.99] vs. living within 25 miles of such a facility). The effect of distance on PMRT appeared to be more pronounced with increasing patient age (>75 years). Variation in the effect of distance on radiation use between regions of the country and nodal status was also identified. CONCLUSIONS: Oncologists must be cognizant of the potential barrier to quality care that is posed by travel distance, especially for elderly patients; and policy makers should consider this fact in resource allocation decisions about radiation treatment centers.

Aged↗
PubMed2006

Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice.

OBJECTIVES: The purpose of this study was to investigate the prognostic value of change in distance walked in 6 min in chronic heart failure (CHF). BACKGROUND: The strongest indication for the 6-min walking test (6MWT) is for measuring the response to therapeutic interventions in patients with CHF. Whether the increase in distance walked after a therapeutic intervention translates into improved clinical outcome is largely unknwon. METHODS: We studied 476 CHF patients with left ventricular systolic dysfunction who were referred to our institution for adjustment of heart failure therapy because of persisting or worsening symptoms. Adjustment of therapy involved four classes of drugs: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, beta-blockers, loop diuretics, and aldosterone antagonists. A standardized 6MWT was performed at baseline and at discharge. RESULTS: After 15.2 +/- 8 days, the distance walked increased from 326 +/- 107 m to 408 +/- 109 m (+25%; p = 0.001). During a mean follow-up of 23.9 months, 94 patients died and 12 patients underwent cardiac transplantation. Among a set of variables, New York Heart Association functional class (p = 0.02), serum creatinine concentration (p = 0.01), left ventricular ejection fraction (p = 0.002), distance walked at baseline (p = 0.0002), and change in distance walked (p = 0.002) were significant independent predictors of survival. When the patients were divided into two subgroups according to the median value of the distance walked at baseline, the increase in walking distance was significantly associated with survival only in the subgroup of patients who walked <340 m at baseline. CONCLUSIONS: Our data indicate that repeating a 6MWT after drug intervention provides independent prognostic information in CHF patients with more compromised exercise capacity.

Aged↗