Thomas A Zelniker1, Dörte Huscher2, Anton Vonk-Noordegraaf3, Ralf Ewert4, Tobias J Lange5, Hans Klose6, Daniel Dumitrescu7, Michael Halank8, Matthis Held9, Henning Gall10, David Pittrow11, Marius M Hoeper12,13, Lutz Frankenstein14. 1. Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. thomas.zelniker@med.uni-heidelberg.de. 2. Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany. 3. Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. 4. Department of Internal Medicine, University of Greifswald, Greifswald, Germany. 5. Department of Internal Medicine II, Division of Pneumology, University Medical Center Regensburg, Regensburg, Germany. 6. Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Center of Oncology, Hamburg, Germany. 7. Herzzentrum der Universität zu Köln, Klinik III für Innere Medizin, Cologne, Germany. 8. Department of Internal Medicine I, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany. 9. Department of Internal Medicine, Respiratory Medicine and Cardiology, MissioClinic, Würzburg, Germany. 10. Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany. 11. Institute for Clinical Pharmacology, Medical Faculty, Technical University Dresden, Dresden, Germany. 12. Department of Respiratory Medicine, Hannover Medical School, 30623, Hannover, Germany. 13. German Centre of Lung Research (DZL/BREATHE), Hannover, Germany. 14. Department of Cardiology, Angiology, Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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.
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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