{"title":"重度主动脉瓣狭窄患者6分钟步行试验的预后价值。","authors":"Norio Kanamori, Yasuaki Takeji, Tomohiko Taniguchi, Takeshi Morimoto, Shinichi Shirai, Kenji Ando, Hiroyuki Tabata, Takeshi Kitai, Nobuhisa Ohno, Ryosuke Murai, Kohei Osakada, Koichiro Murata, Masanao Nakai, Hiroshi Tsuneyoshi, Tomohisa Tada, Masashi Amano, Shin Watanabe, Hiroki Shiomi, Hirotoshi Watanabe, Yusuke Yoshikawa, Ryusuke Nishikawa, Yuki Obayashi, Ko Yamamoto, Mamoru Toyofuku, Shojiro Tatsushima, Makoto Miyake, Hiroyuki Nakayama, Kazuya Nagao, Masayasu Izuhara, Kenji Nakatsuma, Moriaki Inoko, Takanari Fujita, Masahiro Kimura, Mitsuru Ishii, Shunsuke Usami, Fumiko Nakazeki, Kiyonori Togi, Yasutaka Inuzuka, Tatsuhiko Komiya, Koh Ono, Takeshi Aoyama, Kenji Minatoya, Takeshi Kimura","doi":"10.1253/circj.CJ-25-0056","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of the 6-minute walk distance (6MWD) in patients with severe aortic stenosis (AS) has not been thoroughly investigated.</p><p><strong>Methods and results: </strong>This study evaluated 998 patients with severe AS who underwent a 6-min walk test as part of a large multicenter prospective cohort. Patients were categorized as either fast walkers (6MWD ≥300 m; n=515) or slow walkers (6MWD <300 m; n=483). During a median follow-up of 2.3 years, 861 (86.3%) patients underwent surgical or transcatheter aortic valve replacement (AVR; 87.0% of fast walkers vs. 85.5% of slow walkers). The cumulative 3-year incidence of death was significantly lower among fast walkers than slow walkers (10.9% vs. 31.7%; P<0.001). After adjusting for confounders, slow walkers had a significantly higher risk of all-cause mortality than fast walkers (hazard ratio 2.36; 95% confidence interval 1.55-3.58; P<0.001). Stratified analysis by initial treatment strategy revealed that the cumulative 3-year incidence of all-cause death was consistently lower among fast walkers than slow walkers (initial AVR strategy: 10.1% vs. 28.1% [P<0.001]; conservative strategy: 13.4% vs. 46.7% [P<0.001]). Among asymptomatic patients managed conservatively, fast walkers demonstrated a remarkably low cumulative 3-year incidence of all-cause death (8.1%).</p><p><strong>Conclusions: </strong>The 6MWD is a reliable prognostic marker for patients with severe AS, regardless of initial treatment strategy.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1566-1574"},"PeriodicalIF":3.7000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic Value of the 6-Minute Walk Test in Patients With Severe Aortic Stenosis.\",\"authors\":\"Norio Kanamori, Yasuaki Takeji, Tomohiko Taniguchi, Takeshi Morimoto, Shinichi Shirai, Kenji Ando, Hiroyuki Tabata, Takeshi Kitai, Nobuhisa Ohno, Ryosuke Murai, Kohei Osakada, Koichiro Murata, Masanao Nakai, Hiroshi Tsuneyoshi, Tomohisa Tada, Masashi Amano, Shin Watanabe, Hiroki Shiomi, Hirotoshi Watanabe, Yusuke Yoshikawa, Ryusuke Nishikawa, Yuki Obayashi, Ko Yamamoto, Mamoru Toyofuku, Shojiro Tatsushima, Makoto Miyake, Hiroyuki Nakayama, Kazuya Nagao, Masayasu Izuhara, Kenji Nakatsuma, Moriaki Inoko, Takanari Fujita, Masahiro Kimura, Mitsuru Ishii, Shunsuke Usami, Fumiko Nakazeki, Kiyonori Togi, Yasutaka Inuzuka, Tatsuhiko Komiya, Koh Ono, Takeshi Aoyama, Kenji Minatoya, Takeshi Kimura\",\"doi\":\"10.1253/circj.CJ-25-0056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The prognostic significance of the 6-minute walk distance (6MWD) in patients with severe aortic stenosis (AS) has not been thoroughly investigated.</p><p><strong>Methods and results: </strong>This study evaluated 998 patients with severe AS who underwent a 6-min walk test as part of a large multicenter prospective cohort. Patients were categorized as either fast walkers (6MWD ≥300 m; n=515) or slow walkers (6MWD <300 m; n=483). During a median follow-up of 2.3 years, 861 (86.3%) patients underwent surgical or transcatheter aortic valve replacement (AVR; 87.0% of fast walkers vs. 85.5% of slow walkers). The cumulative 3-year incidence of death was significantly lower among fast walkers than slow walkers (10.9% vs. 31.7%; P<0.001). After adjusting for confounders, slow walkers had a significantly higher risk of all-cause mortality than fast walkers (hazard ratio 2.36; 95% confidence interval 1.55-3.58; P<0.001). Stratified analysis by initial treatment strategy revealed that the cumulative 3-year incidence of all-cause death was consistently lower among fast walkers than slow walkers (initial AVR strategy: 10.1% vs. 28.1% [P<0.001]; conservative strategy: 13.4% vs. 46.7% [P<0.001]). Among asymptomatic patients managed conservatively, fast walkers demonstrated a remarkably low cumulative 3-year incidence of all-cause death (8.1%).</p><p><strong>Conclusions: </strong>The 6MWD is a reliable prognostic marker for patients with severe AS, regardless of initial treatment strategy.</p>\",\"PeriodicalId\":50691,\"journal\":{\"name\":\"Circulation Journal\",\"volume\":\" \",\"pages\":\"1566-1574\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1253/circj.CJ-25-0056\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1253/circj.CJ-25-0056","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Prognostic Value of the 6-Minute Walk Test in Patients With Severe Aortic Stenosis.
Background: The prognostic significance of the 6-minute walk distance (6MWD) in patients with severe aortic stenosis (AS) has not been thoroughly investigated.
Methods and results: This study evaluated 998 patients with severe AS who underwent a 6-min walk test as part of a large multicenter prospective cohort. Patients were categorized as either fast walkers (6MWD ≥300 m; n=515) or slow walkers (6MWD <300 m; n=483). During a median follow-up of 2.3 years, 861 (86.3%) patients underwent surgical or transcatheter aortic valve replacement (AVR; 87.0% of fast walkers vs. 85.5% of slow walkers). The cumulative 3-year incidence of death was significantly lower among fast walkers than slow walkers (10.9% vs. 31.7%; P<0.001). After adjusting for confounders, slow walkers had a significantly higher risk of all-cause mortality than fast walkers (hazard ratio 2.36; 95% confidence interval 1.55-3.58; P<0.001). Stratified analysis by initial treatment strategy revealed that the cumulative 3-year incidence of all-cause death was consistently lower among fast walkers than slow walkers (initial AVR strategy: 10.1% vs. 28.1% [P<0.001]; conservative strategy: 13.4% vs. 46.7% [P<0.001]). Among asymptomatic patients managed conservatively, fast walkers demonstrated a remarkably low cumulative 3-year incidence of all-cause death (8.1%).
Conclusions: The 6MWD is a reliable prognostic marker for patients with severe AS, regardless of initial treatment strategy.
期刊介绍：
Circulation publishes original research manuscripts, review articles, and other content related to cardiovascular health and disease, including observational studies, clinical trials, epidemiology, health services and outcomes studies, and advances in basic and translational research.
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