Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement
- D P de Arenaza1,
- J Pepper2,
- B Lees3,
- F Rubinstein4,
- F Nugara3,
- M Roughton2,
- M Jasinski5,
- O Bazzino1,
- M Flather2
- 1Cardiology Department, Hospital Italiano, Buenos Aires, Argentina
- 2Royal Brompton and Harefield NHS Trust, London, UK, and Imperial College, London, UK
- 3Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK
- 4Family Medicine Department, Hospital Italiano, Buenos Aires, Argentina
- 5Medical University of Silesia, Katowice, Poland
- Correspondence to Dr Marcus Flather, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; M.Flather{at}rbht.nhs.uk
- Accepted 5 May 2009
- Published Online First 28 June 2009
Abstract
Aims: The authors investigated the additive prognostic value of the 6-minute walk test (6MWT) to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR)
Methods and results: 208 patients with severe AS underwent the 6MWT before AVR, as part of a randomised trial (ASSERT) comparing stented and stentless aortic valves. Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n = 14) in patients walking <300 metres compared to 4% (n = 4) in those who walked ≥300 metres (p = 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6-minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09 to 0.85, p = 0.025).
Conclusions: The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis before AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score.
Footnotes
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See Editorial, p 97
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Funding The ASSERT study was supported by a research grant from Medtronic, Inc.
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Competing interests DPdA, reimbursement for attending conferences from Medtronic Inc. JP, research grants, reimbursement for attending conferences and fee for speaking from Medtronic Inc. MF, research grants and reimbursement for attending conferences from Medtronic Inc.
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Centres and principal investigators (number of recruited patients): Royal Brompton Hospital, London, UK: John Pepper (n = 60); Medical University of Silesia, 2nd Department Cardiac Surgery, Katowice, Poland: Marek Jasinski (n = 49); UZ Gent, Belgium (n = 35); Ullevaal Sykehus, Oslo, Norway: Mons Lie (n = 31); Medical University of Silesia, 1st Department Cardiac Surgery, Katowice, Poland: Andrzej Bochenek (n = 17); Castle Hill Hospital, Hull, UK: Levent Guvendik (n = 13); Harefield Hospital, Middlesex, UK: Jullien Gaer (n = 11); University Hospital Tromso, Tromso, Norway: Per Erling Dahl (n = 9); Hammersmith Hospital, London, UK: Jon Anderson (n = 8); Edinburgh Royal Infirmary, Edinburgh, Scotland, UK: Pankaj Mankad (n = 1).
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Provenance and Peer review Not commissioned; externally peer reviewed.
