Prognostic Value of the 6-Minute Walk Test in Patients With Severe Aortic Stenosis.
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Kanamori Norio, Takeji Yasuaki, Taniguchi Tomohiko, Morimoto Takeshi, Shirai Shinichi, Ando Kenji, Tabata Hiroyuki, Kitai Takeshi, Ohno Nobuhisa, Murai Ryosuke, Osakada Kohei, Murata Koichiro, Nakai Masanao, Tsuneyoshi Hiroshi, Tada Tomohisa, Amano Masashi, Watanabe Shin, Shiomi Hiroki, Watanabe Hirotoshi, Yoshikawa Yusuke, Nishikawa Ryusuke, Obayashi Yuki, Yamamoto Ko, Toyofuku Mamoru, Tatsushima Shojiro, Miyake Makoto, Nakayama Hiroyuki, Nagao Kazuya, Izuhara Masayasu, Nakatsuma Kenji, Inoko Moriaki, Fujita Takanari, Kimura Masahiro, Ishii Mitsuru, Usami Shunsuke, Nakazeki Fumiko, Togi Kiyonori, Inuzuka Yasutaka, Komiya Tatsuhiko, Ono Koh, Aoyama Takeshi, Minatoya Kenji, Kimura Takeshi, CURRENT AS Registry-2 Investigators
Аннотация
METHODS AND RESULTS: This study evaluated 998 patients with severe AS who underwent a 6-min walk test as part of a large multicenter prospective cohort. Patients were categorized as either fast walkers (6MWD ≥300 m; n=515) or slow walkers (6MWD <300 m; n=483). During a median follow-up of 2.3 years, 861 (86.3%) patients underwent surgical or transcatheter aortic valve replacement (AVR; 87.0% of fast walkers vs. 85.5% of slow walkers). The cumulative 3-year incidence of death was significantly lower among fast walkers than slow walkers (10.9% vs. 31.7%; P<0.001). After adjusting for confounders, slow walkers had a significantly higher risk of all-cause mortality than fast walkers (hazard ratio 2.36; 95% confidence interval 1.55-3.58; P<0.001). Stratified analysis by initial treatment strategy revealed that the cumulative 3-year incidence of all-cause death was consistently lower among fast walkers than slow walkers (initial AVR strategy: 10.1% vs. 28.1% [P<0.001]; conservative strategy: 13.4% vs. 46.7% [P<0.001]). Among asymptomatic patients managed conservatively, fast walkers demonstrated a remarkably low cumulative 3-year incidence of all-cause death (8.1%).
CONCLUSIONS: The 6MWD is a reliable prognostic marker for patients with severe AS, regardless of initial treatment strategy.