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Value of the 6-Minute Walk Test for Risk Assessment in Patients With Hypertrophic Cardiomyopathy
Yu Zhang1, Leqi Wang2, Channa Zhang2
1Cardiomyopathy Ward, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
The 6-minute walk test (6MWT) effectively predicts major adverse cardiovascular events (MACEs) in hypertrophic cardiomyopathy (HCM). This practical test is a valuable alternative to cardiopulmonary exercise testing (CPET) for risk stratification.
Area of Science:
- Cardiology
- Clinical Exercise Physiology
- Preventive Medicine
Background:
- The 6-minute walk test (6MWT) is a widely used functional capacity assessment in cardiovascular diseases.
- Its prognostic value in hypertrophic cardiomyopathy (HCM) has not been previously established.
- Cardiopulmonary exercise testing (CPET) is another method for risk assessment in HCM, but it is more resource-intensive.
Purpose of the Study:
- To evaluate the prognostic significance of the 6MWT in predicting major adverse cardiovascular events (MACEs) in patients with HCM.
- To compare the predictive performance of the 6MWT with CPET parameters, specifically peak oxygen consumption (peak V˙O₂).
Main Methods:
- A cohort of 496 patients diagnosed with HCM who completed both 6MWT and CPET was analyzed.
- The primary endpoint was the occurrence of MACEs over a median follow-up period of 2.7 years.
Main Results:
- The 6MWT distance independently predicted MACEs in HCM patients (adjusted HR 1.646 per 100-m decrease, P = 0.006).
- 6MWT distance showed a comparable ability to predict MACEs as peak V˙O₂ (C-statistic 0.643 vs. 0.616).
- Incorporating 6MWT distance into risk models significantly improved predictive accuracy (C-statistic 0.791 vs. 0.731, P = 0.038), unlike peak V˙O₂.
Conclusions:
- The 6MWT is a practical, cost-effective tool for risk stratification in HCM patients.
- It serves as a viable alternative to CPET, especially when CPET is not feasible or carries higher risks.
Background:
The 6-minute walk test (6MWT) is a practical and cost-effective measure of functional capacity in cardiovascular diseases, yet its prognostic utility in hypertrophic cardiomyopathy (HCM) remains unknown. In this study we aimed to evaluate the prognostic value of the 6MWT and compare it with cardiopulmonary exercise testing (CPET) in HCM.
Methods:
A total of 496 patients with HCM who underwent both 6MWT and CPET were included in this study. The endpoint was major adverse cardiovascular events (MACEs).
Results:
During a median follow-up of 2.7 years, 38 patients developed MACEs. The 6MWT distance was an independent prognostic factor for MACEs in HCM (per 100-m decrease, adjusted hazard ratio [HR] 1.646, P = 0.006), and it correlated significantly with CPET parameters such as peak oxygen consumption (V˙O2; r = 0.328, P < 0.001). The ability of the 6MWT distance to predict MACEs was comparable with peak V˙O2 (C-statistic = 0.643 vs 0.616), with 423 m identified as the optimal cutoff value. Adding the 6MWT distance to the adjusted Cox model significantly improved predictive performance (C-statistic = 0.791 vs 0.731, P = 0.038), whereas adding peak V˙O2 did not (C-statistic = 0.754 vs 0.731, P = 0.346). The 6MWT distance remained an independent predictor of MACEs in patients at increased risk of adverse events during CPET (per 100-m decrease, adjusted HR 1.848, P = 0.037).
Conclusions:
The 6MWT serves as a practical and cost-effective alternative to CPET for risk stratification in HCM, particularly when CPET is unavailable or poses risks.
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