RT Journal Article
SR Electronic
T1 Prognostic importance of the 6 min walk test in light chain (AL) amyloidosis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1616
OP 1622
DO 10.1136/heartjnl-2021-320703
VO 108
IS 20
A1 Oliver C Cohen
A1 Ananth Sathyanath
A1 Aviva Petrie
A1 Sriram Ravichandran
A1 Steven Law
A1 Richa Manwani
A1 Darren Foard
A1 Sajitha Sachchithanantham
A1 Shameem Mahmood
A1 Ana Martinez-Naharro
A1 Marianna Fontana
A1 Carol J Whelan
A1 Philip N Hawkins
A1 Helen J Lachmann
A1 Julian D Gillmore
A1 Ashutosh D Wechalekar
YR 2022
UL http://heart.bmj.com/content/108/20/1616.abstract
AB Objectives In AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is required. We aimed to evaluate the prognostic impact of the 6MWT at baseline and change following chemotherapy.Methods This study evaluated the outcomes of patients who enrolled in a prospective observational study at the UK National Amyloidosis Centre (2012–2017). Patients underwent comprehensive assessments inclusive of blood testing, echocardiogram and 6MWT at baseline and annually thereafter.Results In total, 799 patients were included within the study. Median baseline 6 min walk distance (6MWD) was 362 m (IQR: 231 m). 6MWD progressively decreased with worsening cardiac disease stage (458 m, 404 m, 331 m and 168 m for cardiac Mayo stages I, II, IIIa and IIIb, respectively (p<0.0001)). In patients with a baseline 6MWT of ≥350 m, the median overall survival was not reached (vs 30.0 (95% CI 23.2 to 36.8) months if <350 m and 5.0 (95% CI 2.8 to 7.2) months if unable to attempt 6MWT (p<0.0001). Following chemotherapy, only patients in a complete haematological response improved their 6MWD by 12 months (p=0.001). Improvement in 6MWD prolonged survival in patients with cardiac amyloidosis (p=0.005).Conclusion The 6MWT is prognostic in AL amyloidosis. A baseline distance of ≥350 m independently predicts better survival. These data suggest that 6MWT has utility in AL amyloidosis for baseline prognosis and assessing response.Due to ethical and confidentiality considerations, data cannot be shared but interested parties may directly contact the authors for any queries.