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Prognostic importance of the 6 min walk test in light chain (AL) amyloidosis.

Authors:
Oliver C Cohen Ananth Sathyanath Aviva Petrie Sriram Ravichandran Steven Law Richa Manwani Darren Foard Sajitha Sachchithanantham Shameem Mahmood Ana Martinez-Naharro Marianna Fontana Carol J Whelan Philip N Hawkins Helen J Lachmann Julian D Gillmore Ashutosh D Wechalekar

Heart 2022 Jun 28. Epub 2022 Jun 28.

National Amyloidosis Centre, University College London (Royal Free Campus), London, UK

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.

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http://dx.doi.org/10.1136/heartjnl-2021-320703DOI Listing
June 2022

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