Background: The clinical determinants of six-minute walk test (6-MWT) performance in patients with left ventricular systolic dysfunction (LVSD) have rarely been investigated, and it is not clear whether they differ from patients referred for the assessment of symptoms of heart failure who do not have major structural heart disease (MSHD). Methods and Results: 571 patients with LVSD enrolled in a chronic disease management programme (79% male; mean age 71 T10 years; BMI 28 T 5) completed a 6-MWT with a mean distance 337 T 103 m. 688 patients referred with suspected heart failure but in whom MSHD was excluded (49% male; mean age 70 T 11 years; BMI 28 T 6) had a mean 6-MWT distance of 391 T106 m ( P < 0.001 compared to patients with LVSD). Relationships with walking distance were determined by calculating odds ratios (ORs) with 95% confidence intervals (CIs) for walking 300 versus > 300 m. In patients with LVSD, predictors of poor walking distance ( 300 m) included age ! 75 years (OR = 4.0, 95% CI = 2.4 -6.4); low BMI (< 20) (OR = 3.4, 95% CI = 1.6 -7.3); anaemia (OR = 2.8, 95% CI = 1.8 -4.2); resting heart rate > 80 beatsImin À 1 (OR = 2.2, 95% CI = 1.3 -3.5); and being female (OR = 2.0, 95% CI = 1.3 -3.0). Serum creatinine and NT-proBNP showed dose -response effects, as did self-perceived feelings of depression and anxiety. Determinants of 6-MWT in patients without MSHD were similar including age ! 75 years (OR = 6.0, 95% CI = 3.4 -10.4), anaemia (OR = 2.8, 95% CI = 1.6 -4.9), resting HR > 80 beatsImin À 1 (OR = 2.5, 95% CI = 1.4 -4.4) and being female (OR = 1.6, 95% CI = 1.9 -2.4). NT-proBNP and self-perceived feelings of depression and anxiety also showed doseresponse effects. Conclusion: The determinants of poor 6-MWT performance depend on physical -cardiovascular and non-cardiovascular, and psychological factors. Clinical predictors for poor walking performance are similar for patients with LVSD and without MSHD.

Together, these findings confirm that EMCV was responsible for deaths of the two bonobos. Strict separation of bonobos in particular and captive primates in general from potential sources of EMCV contamination should be maintained to prevent mortality caused by EMCV.

This article continues a series of reports summarising recent research developments pertinent to the topic of heart failure. This is a summary of presentations made at Scientific Sessions of Heart Failure 2001, a meeting of the Working Group on Heart Failure of the European Society of Cardiology. Clinical studies of particular interest to people caring for patients with heart failure include CONTAK-CD, CHRISTMAS and further updates on OPTIME-CHF. A brief review of the current status of cardiac resynchronisation therapy is included. ᮊ

We report the first probable identification of encephalomyocarditis virus (EMCV) in a bonobo (Pan paniscus) that had been part of a forest re-introduction programme. Clinical presentation was of episodic acute on chronic heart failure and cerebral infarction with end-stage renal failure rather than sudden death which is more commonly associated with EMCV infection. A postmortem diagnosis of probable EMCV was made using gross pathological and histopathological examination. Findings included acute on chronic heart failure combined with the unusual but characteristic histopathological features of non-suppurative necrotizing myocarditis with mononuclear, inflammatory infiltration of the brain.

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