The 6MWT as a prognostic tool in pulmonary arterial hypertension: results from the COMPERA registry

Clin Res Cardiol. 2018 Jun;107(6):460-470. doi: 10.1007/s00392-018-1207-5. Epub 2018 Jan 24.


Background: In patients with pulmonary arterial hypertension, the 6-Minute Walk Test (6MWT) is recommended for risk stratification and follow-up by all guidelines. However, the prognostic value of the 6MWT has been discussed controversially. We sought to compare and validate all published 6MWT cut-off points.

Methods: From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)-registry we identified 2391 patients with pulmonary arterial hypertension who had at least one documented 6MWT measurement. A Medline search identified a total of 21 different threshold values for either single-point or change of 6MWT. All values were tested individually for prognostication of 1-year, 2-year and 3-year all-cause mortality.

Results: The highest positive likelihood ratio was a cut-off value < 165 ms, whereas the best negative likelihood ratio was found to be a threshold of 440 ms. Furthermore, improvement in 6MWT had considerably less predictive value on mortality and survival than deterioration. Moreover, absolute single-point values outperformed change values for both improvement and worsening.

Conclusion: Our data confirmed the prognostic relevance of the 6MWT and support the cut-off values stated in most recent guidelines. Furthermore, these results explain why changes in 6MWT did not correlate consistently with prognosis in previous studies.

Keywords: 6-Minute walk test; Cut-off value; PAH; Pulmonary arterial hypertension; Risk stratification.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Cause of Death / trends
  • Exercise Test / methods*
  • Exercise Tolerance / physiology*
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / epidemiology
  • Hypertension, Pulmonary / physiopathology
  • Male
  • Middle Aged
  • Morbidity / trends
  • Prognosis
  • Prospective Studies
  • Pulmonary Wedge Pressure / physiology*
  • Registries*
  • Risk Assessment / methods*
  • Survival Rate / trends