Key result
Longer 6MWTD linked to ~1% lower CV death risk per 10 meters in HFrEF.
Why the study?
The prognostic impact of baseline 6 min walk test distance on major cardiovascular events in HFrEF and relevant subgroups was not fully characterized.
Cohort (n=2,102)
Hazard Ratio: 0.989
p-value: p=0.011
A 6-minute walk test distance of 200 meters serves as a useful prognostic cut-off for predicting mortality and heart failure hospitalization in patients with HFrEF.
May refine HFrEF risk stratification; leaves open incremental value over standard markers in prospective validation.
AIMS: This study aimed to investigate the impact of baseline 6 min walk test distance (6MWTD) on time to major cardiovascular (CV) events in heart failure with reduced ejection fraction (HFrEF) and its impact in clinically relevant subgroups. METHODS AND RESULTS: In the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial, 6MWTD at baseline was available in 2102 HFrEF patients. Median follow-up was 3.4 years. All-cause death and heart failure hospitalization (HFH) exhibited a significant non-linear relationship with 6MWTD (P = 0.023 and 0.032, respectively), whereas a significant association between 6MWTD and CV death was shown in a linear model [hazard ratio (HR) per 10 m increase, 0.989; P = 0.011]. In linear splines with the best cut-off point at 200 m, the positive effect of a longer 6MWTD on all-cause death and HFH was only observed for 6MWTD > 200 m (HR per 10 m increase, 0.987; P = 0.0036 and 0.986; P = 0.0022, respectively). The associations between 6MWTD and CV outcomes were consistent across clinical subgroups; for age, a significant relationship between 6MWTD and HFH was observed in patients ≥60 years (HR per 10 m increase, 0.98; P < 0.001), but not in patients <60 years (HR per 10 m increase, 1.00; P = 0.98; P = 0.02 for the interaction). CONCLUSIONS: In HFrEF, 6MWTD is independently associated with all-cause death, CV death, and HFH. 6MWTD of 200 m is the best cut-off point for predicting these adverse events. The prognostic impact of 6MWTD for HFH was only observed in older patients.
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Matsumoto et al. (2020) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=2,102). 6 min walk test distance (6MWTD) was evaluated on Cardiovascular death (HR 0.989, p=0.011). In patients with HFrEF, a longer baseline 6-minute walk test distance was associated with a reduced risk of cardiovascular death (HR 0.989 per 10 m increase, P=0.011).
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