The 6-min walk test in transthyretin cardiac amyloidosis: prognostic utility put to the real-world test.

ABSTRACT:

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.

SUBMITTER: Poledniczek M 

PROVIDER: S-EPMC12450996 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature