Key result
Faster gait speed gains predict improved 6MWD and lower mortality in CVD patients.
Why the study?
Repeated assessment of 6-minute walk distance (6MWD) is challenging in daily clinical practice, and while gait speed (GS) may serve as a simple surrogate marker, the magnitude of change in GS that predicts a clinically meaningful improvement in 6MWD across different age groups was unclear.
Does achieving age-specific cutoff values for change in gait speed predict improvement in 6-minute walk distance and lower all-cause mortality in patients with cardiovascular disease?
Cohort (n=1,872)
Does achieving age-specific cutoff values for change in gait speed predict improvement in 6-minute walk distance and lower all-cause mortality in patients with cardiovascular disease?
Age-specific gait speed improvement cutoffs (0.14 m/s for patients < 65 years and 0.08 m/s for patients ≥ 65 years) serve as practical surrogate markers for predicting clinically meaningful 6-minute walk distance improvements and lower all-cause mortality in cardiovascular disease patients.
Background/Introduction Changes in 6-minute walk distance (6MWD) are established prognostic indicators in patients with cardiovascular disease (CVD). However, repeated assessment of 6MWD may be challenging in daily clinical practice. Gait speed (GS) may serve as a simple surrogate marker for 6MWD, but the magnitude of change in GS that predicts a clinically meaningful improvement in 6MWD remains unclear, particularly across different age groups. Purpose The purpose of this study was to determine the cutoff values for changes in GS that predict improvement in 6MWD in patients with CVD. Methods We studied 1,872 patients with CVD who were assessed for 6MWD and GS at discharge and 5 months post-discharge, and for whom longitudinal changes were available. 6MWD improvement was defined as an increase of ≥ 30 m from baseline. Using receiver operating characteristic curve analysis and the Youden index, we calculated cutoff values for changes in GS to predict 6MWD improvement for the total cohort and age-stratified groups (non-older: < 65 years; older: ≥ 65 years). The association between 6MWD improvement and improvement in GS meeting or exceeding the age-specific cutoff values was examined using multivariate logistic regression analysis. Furthermore, after defining patients who showed an improvement equal to or greater than the age-specific GS cutoff values as the improvement group, we examined the association between the age-specific GS cutoffs and all-cause mortality using a landmark analysis. In this analysis, patients who died within 150 days after discharge or became untraceable were excluded. Results The cutoff values for changes in GS to predict 6MWD improvement were 0.14 m/s for the total cohort [area under the curve (AUC): 0.68, sensitivity: 0.52, specificity: 0.76], 0.14 m/s for the non-older group (AUC: 0.64, sensitivity: 0.50, specificity: 0.72), and 0.08 m/s for the older group (AUC: 0.70, sensitivity: 0.66, specificity: 0.65). In the multivariate logistic regression analysis, an improvement in GS equal to or greater than the age-specific cutoff values was significantly associated with 6MWD improvement. In the landmark analysis, the GS improvement group defined by age-specific cutoff values was associated with a significantly lower all-cause mortality rate compared with the non-improvement group. Conclusion In patients with CVD, the cutoff values for changes in GS to predict 6MWD improvement were 0.14 m/s for the total cohort and non-older patients, and 0.08 m/s for older patients. Furthermore, the cutoff values identified in this study were associated with all-cause mortality. Changes in GS may serve as a practical surrogate marker for longitudinal assessment in patients with CVD, suggesting that GS improvement goals may need to be considered according to age.
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Sato et al. (2026) conducted a cohort in Cardiovascular disease (n=1,872). Change in gait speed (GS) meeting or exceeding age-specific cutoffs (≥0.14 m/s for <65 years, ≥0.08 m/s for ≥65 years) vs. Change in gait speed below age-specific cutoff values was evaluated on Improvement in 6-minute walk distance (increase ≥30 m from baseline) and all-cause mortality (AUC 0.68). Gait speed increases of ≥0.14 m/s (<65 years; AUC 0.64) and ≥0.08 m/s (≥65 years; AUC 0.70) predicted 6MWD improvement (≥30 m) and lower all-cause mortality in CVD patients.
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