Prognostic Value of a 6-Minute Walk Test in Patients With Transthyretin Cardiac Amyloidosis,Journal of the American College of Cardiology

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Prognostic Value of a 6-Minute Walk Test in Patients With Transthyretin Cardiac Amyloidosis
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2024-05-13 , DOI: 10.1016/j.jacc.2024.04.011
Adam Ioannou ₁ , Carlo Fumagalli ₂ , Yousuf Razvi ₁ , Aldostefano Porcari ₃ , Muhammad U Rauf ₁ , Ana Martinez-Naharro ₁ , Lucia Venneri ₁ , William Moody ₄ , Richard P Steeds ₄ , Aviva Petrie ₅ , Carol Whelan ₁ , Ashutosh Wechalekar ₁ , Helen Lachmann ₁ , Philip N Hawkins ₁ , Scott D Solomon ₆ , Julian D Gillmore ₁ , Marianna Fontana ₁

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The 6-minute walk test (6MWT) represents a comprehensive functional assessment that is commonly used in patients with heart failure; however, data are lacking in patients with transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to assess the prognostic importance of the 6MWT in patients with ATTR-CA. A retrospective analysis of patients diagnosed with ATTR-CA at the National Amyloidosis Centre who underwent a baseline 6MWT between 2011 and 2023 identified 2,141 patients, of whom 1,118 had follow-up at 1 year. The median baseline 6MWT distance was 347 m (Q1-Q3: 250-428 m) and analysis by quartiles demonstrated an increased death rate with each distance reduction (deaths per 100 person-years: 6.3 vs 9.2 vs 13.6 vs 19.0; log-rank < 0.001). A 6MWT distance of <350 m was associated with a 2.2-fold higher risk of mortality (HR: 2.15; 95% CI: 1.85-2.50; < 0.001), with a similar increased risk across National Amyloidosis Centre disease stages ( for interaction = 0.761) and genotypes ( for interaction = 0.172). An absolute (reduction of >35 m) and relative worsening (reduction of >5%) of 6MWT at 1 year was associated with an increased risk of mortality (HR: 1.80; 95% CI: 1.51-2.15; < 0.001 and HR: 1.89; 95% CI: 1.59-2.24; < 0.001, respectively), which was similar across the aforementioned subgroups. When combined with established measures of disease progression (N-terminal pro–B-type natriuretic peptide progression and outpatient diuretic intensification), each incremental increase in progression markers was associated with an increased death rate (deaths per 100 person-years: 7.6 vs 13.9 vs 22.4 vs 32.9; log-rank < 0.001). The baseline 6MWT distance can refine risk stratification beyond traditional prognosticators. A worsening 6MWT distance can stratify disease progression and, when combined with established markers, identifies patients at the highest risk of mortality.

中文翻译：

6 分钟步行测试对运甲状腺素蛋白心脏淀粉样变性患者的预后价值

6分钟步行测试（6MWT）代表一种综合功能评估，常用于心力衰竭患者；然而，缺乏转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）患者的数据。本研究旨在评估 6MWT 对 ATTR-CA 患者预后的重要性。对 2011 年至 2023 年间在国家淀粉样变性中心诊断为 ATTR-CA 并接受基线 6MWT 的患者进行回顾性分析，确定了 2,141 名患者，其中 1,118 名患者进行了 1 年随访。中位基线 6MWT 距离为 347 m（Q1-Q3：250-428 m），四分位数分析表明，死亡率随着距离的每次减小而增加（每 100 人年死亡人数：6.3 vs 9.2 vs 13.6 vs 19.0；对数秩< 0.001)。 6MWT 距离 <350 id=0>35 m）和 1 年时 6MWT 相对恶化（降低 >5%）与死亡风险增加相关（HR：1.80；95% CI：1.51-2.15；< 0.001 和 HR：1.89；95% CI：1.59-2.24；< 0.001），上述亚组的情况相似。当与既定的疾病进展指标（N 端 B 型利钠肽进展和门诊利尿剂强化）相结合时，进展标志物的每次增量增加都与死亡率的增加相关（每 100 人年死亡人数：7.6 比 13.9） vs 22.4 vs 32.9；对数秩 < 0.001)。基线 6MWT 距离可以超越传统预测器来细化风险分层。恶化的 6MWT 距离可以对疾病进展进行分层，并与已建立的标志物相结合，识别死亡风险最高的患者。

更新日期：2024-05-13

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