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

Autor:	Cohen OC; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Sathyanath A; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Petrie A; Eastman Dental Institute, University College London, London, UK., Ravichandran S; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Law S; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Manwani R; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Foard D; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Sachchithanantham S; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Mahmood S; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Martinez-Naharro A; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Fontana M; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Whelan CJ; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Hawkins PN; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Lachmann HJ; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Gillmore JD; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK., Wechalekar AD; National Amyloidosis Centre, University College London (Royal Free Campus), London, UK a.wechalekar@ucl.ac.uk.; Department of Haematology, University College London Hospitals, London, UK.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2022 Sep 26; Vol. 108 (20), pp. 1616-1622. Date of Electronic Publication: 2022 Sep 26.
DOI:	10.1136/heartjnl-2021-320703
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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