The 6MWT as a prognostic tool in pulmonary arterial hypertension: results from the COMPERA registry

Thomas A Zelniker, Dörte Huscher, Anton Vonk-Noordegraaf, Ralf Ewert, Tobias J Lange, Hans Klose, Daniel Dumitrescu, Michael Halank, Matthis Held, Henning Gall, David Pittrow, Marius M Hoeper, Lutz Frankenstein

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: In patients with pulmonary arterial hypertension, the 6-Minute Walk Test (6MWT) is recommended for risk stratification and follow-up by all guidelines. However, the prognostic value of the 6MWT has been discussed controversially. We sought to compare and validate all published 6MWT cut-off points.

METHODS: From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)-registry we identified 2391 patients with pulmonary arterial hypertension who had at least one documented 6MWT measurement. A Medline search identified a total of 21 different threshold values for either single-point or change of 6MWT. All values were tested individually for prognostication of 1-year, 2-year and 3-year all-cause mortality.

RESULTS: The highest positive likelihood ratio was a cut-off value < 165 ms, whereas the best negative likelihood ratio was found to be a threshold of 440 ms. Furthermore, improvement in 6MWT had considerably less predictive value on mortality and survival than deterioration. Moreover, absolute single-point values outperformed change values for both improvement and worsening.

CONCLUSION: Our data confirmed the prognostic relevance of the 6MWT and support the cut-off values stated in most recent guidelines. Furthermore, these results explain why changes in 6MWT did not correlate consistently with prognosis in previous studies.

Original languageEnglish
Pages (from-to)460-470
Number of pages11
JournalClinical Research in Cardiology
Volume107
Issue number6
DOIs
Publication statusPublished - Jun 2018

Keywords

  • Cause of Death/trends
  • Exercise Test/methods
  • Exercise Tolerance/physiology
  • Female
  • Follow-Up Studies
  • Germany/epidemiology
  • Humans
  • Hypertension, Pulmonary/diagnosis
  • Male
  • Middle Aged
  • Morbidity/trends
  • Prognosis
  • Prospective Studies
  • Pulmonary Wedge Pressure/physiology
  • Registries
  • Risk Assessment/methods
  • Survival Rate/trends

Cite this