Frontiers in medicine · 2025
The 6-min walk test in transthyretin cardiac amyloidosis: prognostic utility put to the real-world test.
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Poledniczek Michael, Grubmüller Anna, Kronberger Christina, Willixhofer Robin, Ermolaev Nikita, Rettl René, Binder Christina, Camuz Ligios Luciana, Eslami Mahshid, Gregshammer Bernhard, List Luca, Nitsche Christian, Kammerlander Andreas Anselm, Hengstenberg Christian, Kastner Johannes, Bergler-Klein Jutta, Badr Eslam Roza, Duca Franz
Аннотация
BACKGROUND: The 6-min walk test distance (6MWD) was identified as a predictor of mortality in transthyretin amyloid cardiomyopathy (ATTR-CM). However, its real-world applicability remains uncertain, as only therapy-naïve patients were included in the primary analysis.
METHODS: Patients from a prospective ATTR-CM registry were analyzed and included if a 6MWT was completed at baseline.
RESULTS: A total of 252 patients [79.8 years, interquartile range (IQR): 75.4-83.7] were included. After a median of 21.7 (IQR: 12.7-34.1) months, 61 (24.2%) patients died. A 6MWD of <350 m was associated with worse survival [hazard ratio (HR): 3.29, 95% confidence interval (CI): 1.94-5.55, p < 0.001], even after adjusting for National Amyloidosis Centre stage (HR: 2.30, 95% CI: 1.29-4.10, p = 0.005). The Δ6MWD thresholds of <-35 meters/-5% were only associated with mortality after adjusting for change in treatment status.
CONCLUSION: The 6MWD is independently associated with mortality in ATTR-CM irrespective of treatment status. A baseline 6MWD of <350 m is associated with a ~3-fold risk for all-cause mortality. However, our results suggest that the Δ6MWD should only be used in patients on stable background therapy for the estimation of prognosis.
METHODS: Patients from a prospective ATTR-CM registry were analyzed and included if a 6MWT was completed at baseline.
RESULTS: A total of 252 patients [79.8 years, interquartile range (IQR): 75.4-83.7] were included. After a median of 21.7 (IQR: 12.7-34.1) months, 61 (24.2%) patients died. A 6MWD of <350 m was associated with worse survival [hazard ratio (HR): 3.29, 95% confidence interval (CI): 1.94-5.55, p < 0.001], even after adjusting for National Amyloidosis Centre stage (HR: 2.30, 95% CI: 1.29-4.10, p = 0.005). The Δ6MWD thresholds of <-35 meters/-5% were only associated with mortality after adjusting for change in treatment status.
CONCLUSION: The 6MWD is independently associated with mortality in ATTR-CM irrespective of treatment status. A baseline 6MWD of <350 m is associated with a ~3-fold risk for all-cause mortality. However, our results suggest that the Δ6MWD should only be used in patients on stable background therapy for the estimation of prognosis.