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24.01.2018 | Original Paper | Ausgabe 6/2018

Clinical Research in Cardiology 6/2018

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

Zeitschrift:
Clinical Research in Cardiology > Ausgabe 6/2018
Autoren:
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

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.

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