TY - JOUR

T1 - Six-minute walking test and long term prognosis in patients with asymptomatic aortic valve stenosis

AU - Sigvardsen, Per Ejlstrup

AU - Larsen, Linnea Hornbech

AU - Carstensen, Helle Gervig

AU - Kühl, Jørgen Tobias

AU - Møgelvang, Rasmus

AU - Hassager, Christian

AU - Køber, Lars

AU - Kofoed, Klaus Fuglsang

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Management of asymptomatic patients with aortic valve stenosis is challenging due to the elusive relationship between symptomatic status and hemodynamic parameters in addition to the occurrence of cardiovascular death. The 6-minute walking test (6MWT) reflects overall hemodynamic function and could contribute to risk assessment in such patients.METHODS AND RESULTS: One hundred sixteen asymptomatic patients (peak velocity>2.5m/s and left ventricular ejection fraction >50% assessed by echocardiographic screening; 85 males; aged 72±8years) underwent clinical workup, transthoracic echocardiography and a 6MWT. The mean distance covered by patients able to perform the 6MWT (n=107) was 422±90m. Patients were grouped in tertiles according to distance covered in the 6MWT: Short, intermediate and long distance patients. During a median follow-up of 5.5years (IQR 4.5-6.3), 29 (25%) patients died, 10 (9%) from cardiovascular causes. Multivariate analysis revealed that short distance patients (≤390m) were at higher risk of all-cause mortality (HR: 2.44; 95% CI: 1.05-5.67; p=0.04) and cardiovascular mortality (HR: 6.12; 95% CI: 1.18-31.83; p=0.03). For every 100m covered, the risk of all-cause mortality decreased by 35% (HR: 0.65; 95% CI: 0.43-0.99; p=0.04). Long distance patients (>465m) did not experience cardiovascular deaths during follow-up.CONCLUSIONS: In asymptomatic patients with aortic valve stenosis, the 6MWT is an independent predictor of all-cause and cardiovascular mortality. It is of incremental value to the echocardiographic evaluation, suggesting that the 6MWT might be useful to guide clinical follow-up intervals and treatment strategy.

AB - BACKGROUND: Management of asymptomatic patients with aortic valve stenosis is challenging due to the elusive relationship between symptomatic status and hemodynamic parameters in addition to the occurrence of cardiovascular death. The 6-minute walking test (6MWT) reflects overall hemodynamic function and could contribute to risk assessment in such patients.METHODS AND RESULTS: One hundred sixteen asymptomatic patients (peak velocity>2.5m/s and left ventricular ejection fraction >50% assessed by echocardiographic screening; 85 males; aged 72±8years) underwent clinical workup, transthoracic echocardiography and a 6MWT. The mean distance covered by patients able to perform the 6MWT (n=107) was 422±90m. Patients were grouped in tertiles according to distance covered in the 6MWT: Short, intermediate and long distance patients. During a median follow-up of 5.5years (IQR 4.5-6.3), 29 (25%) patients died, 10 (9%) from cardiovascular causes. Multivariate analysis revealed that short distance patients (≤390m) were at higher risk of all-cause mortality (HR: 2.44; 95% CI: 1.05-5.67; p=0.04) and cardiovascular mortality (HR: 6.12; 95% CI: 1.18-31.83; p=0.03). For every 100m covered, the risk of all-cause mortality decreased by 35% (HR: 0.65; 95% CI: 0.43-0.99; p=0.04). Long distance patients (>465m) did not experience cardiovascular deaths during follow-up.CONCLUSIONS: In asymptomatic patients with aortic valve stenosis, the 6MWT is an independent predictor of all-cause and cardiovascular mortality. It is of incremental value to the echocardiographic evaluation, suggesting that the 6MWT might be useful to guide clinical follow-up intervals and treatment strategy.

U2 - 10.1016/j.ijcard.2017.09.183

DO - 10.1016/j.ijcard.2017.09.183

M3 - Journal article

C2 - 28982541

VL - 249

SP - 334

EP - 339

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -