Data-driven discovery and validation of circulating blood-based biomarkers associated with prevalent atrial fibrillation
European Heart Journal, 2018
Chua W., Purmah Y., Cardoso V., Gkoutos G., Tull S., Neculau G., Thomas M., Kotecha D., Lip G., Kirchhof P., Fabritz L.
| Disease area | Application area | Sample type | Products |
|---|---|---|---|
CVD | Surrogate Endpoint | Plasma |  Olink Target 96 |
Abstract
Background:
The 6-minute walk test (6MWT) is a simple and inexpensive way of measuring exercise capacity in patients with heart failure (HF) that predicts morbidity and mortality. However, there are few reports from large multicentre cohorts assessing the predictive value of baseline and changing walk distance.
Methods and results:
In BIOSTAT-CHF, a 6MWT was performed at baseline (n=1714) and 9 months (n=1520). Cox proportional hazards models were used to assess the associations between 6MWT distance and the composite of HF hospitalization and/or death. Median follow-up was 21 months. The median (pct25-75) of the 6MWT distance at baseline was 300m (200–388 m). Independent predictors of a shorter 6MWT distance included older age, female sex, higher heart rate, New York Heart Association class III/IV, orthopnoea, ischaemic heart disease, a previous stroke, current
malignancy, and higher N-terminal pro-B-type natriuretic peptide (all P <0.05). Patients in the lowest baseline 6MWT tertile (≤240 m) were less likely to receive guideline-recommended doses of disease-modifying therapies (P 360 m), those in the lowest and middle tertiles had a worse prognosis [adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.38–2.18]. Patients with a decrease in the distance walked had a worse prognosis (adjusted HR for each 50m decrease 1.09, 95% CI 1.06–1.12). 6MWT distance was not modified by treatment up-titration nor the 6MWT improved the BIOSTAT-CHF prognostic models.
Conclusions:
The 6-minute walk test distance at baseline and a decline in walking distance were both associated with worse prognosis but did not improve the prognostic models. 6MWT distance was not modified by treatment up-titration and its use for assessing the benefits of pharmacologic treatment up-titration may be limited.