Key result
A 6-minute walk distance <300 m is linked to ~136% higher mortality in severe aortic stenosis.
Why the study?
The prognostic significance of the 6-minute walk distance in patients with severe aortic stenosis had not been thoroughly investigated.
Does a 6-minute walk distance ≥300 m predict lower mortality in patients with severe aortic stenosis?
Cohort (n=998)
Yes
Does a 6-minute walk distance ≥300 m predict lower mortality in patients with severe aortic stenosis?
Hazard Ratio: 2.36 (95% CI 1.55–3.58)
Absolute Event Rate: 31.7% vs 10.9%
p-value: p=<0.001
The 6-minute walk test is a reliable prognostic marker in severe aortic stenosis, with a distance <300 m independently predicting higher all-cause mortality regardless of treatment strategy.
Supports 6MWT for risk stratification in severe AS; leaves open prospective validation before guiding decisions.
BACKGROUND: The prognostic significance of the 6-minute walk distance (6MWD) in patients with severe aortic stenosis (AS) has not been thoroughly investigated. 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.
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Kanamori et al. (2025) conducted a cohort in Severe aortic stenosis (n=998). 6-minute walk distance <300 m vs. 6-minute walk distance ≥300 m was evaluated on All-cause death (HR 2.36, 95% CI 1.55-3.58, p=<0.001). A 6-minute walk distance of <300 m was associated with a significantly higher risk of all-cause mortality compared to a distance of ≥300 m in patients with severe aortic stenosis (HR 2.36).
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