Six-Minute Walk Distance and Long-Term Outcomes in Contemporary Left Ventricular Assist Device Recipients: The ELEVATE Registry
Abstract
Objectives: This study aimed to assess the prognostic value of six-minute walk distance (6MWD) in stable HeartMate 3 (HM3) recipients.
Methods: Data from patients with available 6MWD at 6 months post-implant were obtained from the prospective, multicentre ELEVATE registry. Overall survival and adverse event rates were analysed using Cox regression models adjusted for age and sex, with 6MWD as a continuous predictor, and stratified by median distance (350 m).
Results: Six-minute walk distance at 6 months was available in 194 HM3 recipients. Patients walking < median were older (57 vs 52 years, P = .002), had more comorbidities, and reported lower quality of life. Six-minute walk distance correlated positively with haemoglobin (r = 0.20, P = .006) and EuroQoL-5 Dimensions visual analogue scale (EQ-5D VAS) (r = 0.23, P = .004), and inversely with New York Heart Association (NYHA) class (r = –0.47, P < .0001). Kaplan-Meier analyses of patients walking < or ≥ 350 m showed no significant differences in survival (log-rank P = .379), right heart failure (HF) (P = .334), or rehospitalization (P = .243), while survival free from haemocompatibility-related adverse events differed significantly, although marginally (P = .049). Cox models confirmed that 6MWD had no independent prognostic value for mortality (HR 0.98, 95% CI, 0.96-1.01, P = .26) or secondary outcomes. However, patients with < median 6MWD experienced higher rates of major bleeding (Incidence rate ratio (IRR) 2.88, P < .001), major infection (IRR 2.14, P < .0001), and renal dysfunction (IRR 4.78, P = .033).
Conclusions: Shorter 6MWD 6 months after HM3 implantation was associated with a higher risk of some adverse events (AEs) but was not prognostic for mortality, HF recurrence, or rehospitalization risk. The prognostic value of 6MWD in HF patients without circulatory support cannot be extrapolated to patients treated with current left ventricular assist devices (LVADs).
Clinical trial registration number: ClinicalTrials.gov Identifier: NCT02497950.
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BibTeX
@article{nielsen2026sixminute,
title = {{Six-Minute Walk Distance and Long-Term Outcomes in Contemporary Left Ventricular Assist Device Recipients: The ELEVATE Registry}},
author = {William Herrik Nielsen and Finn Gustafsson and Steven Shaw and Jens Garbade and Michiel Morshuis and Daniel Zimpfer and Jacob Lavee and Laura Walker and Carlye Kraemer and Carlo Gazzola and Diyar Saeed and ELEVATE Registry Investigators},
journal = {Interdisciplinary Cardiovascular and Thoracic Surgery},
year = {2026},
month = sep,
doi = {10.1093/icvts/ivag241},
url = {https://doi.org/10.1093/icvts/ivag241},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Six-Minute Walk Distance and Long-Term Outcomes in Contemporary Left Ventricular Assist Device Recipients: The ELEVATE Registry
AU - William Herrik Nielsen
AU - Finn Gustafsson
AU - Steven Shaw
AU - Jens Garbade
AU - Michiel Morshuis
AU - Daniel Zimpfer
AU - Jacob Lavee
AU - Laura Walker
AU - Carlye Kraemer
AU - Carlo Gazzola
AU - Diyar Saeed
AU - ELEVATE Registry Investigators
PY - 2026
DA - 2026/09/11
JO - Interdisciplinary Cardiovascular and Thoracic Surgery
DO - 10.1093/icvts/ivag241
UR - https://doi.org/10.1093/icvts/ivag241
AB - Objectives: This study aimed to assess the prognostic value of six-minute walk distance (6MWD) in stable HeartMate 3 (HM3) recipients. Methods: Data from patients with available 6MWD at 6 months post-implant were obtained from the prospective, multicentre ELEVATE registry. Overall survival and adverse event rates were analysed using Cox regression models adjusted for age and sex, with 6MWD as a continuous predictor, and stratified by median distance (350 m). Results: Six-minute walk distance at 6 months was available in 194 HM3 recipients. Patients walking < median were older (57 vs 52 years, P = .002), had more comorbidities, and reported lower quality of life. Six-minute walk distance correlated positively with haemoglobin (r = 0.20, P = .006) and EuroQoL-5 Dimensions visual analogue scale (EQ-5D VAS) (r = 0.23, P = .004), and inversely with New York Heart Association (NYHA) class (r = –0.47, P < .0001). Kaplan-Meier analyses of patients walking < or ≥ 350 m showed no significant differences in survival (log-rank P = .379), right heart failure (HF) (P = .334), or rehospitalization (P = .243), while survival free from haemocompatibility-related adverse events differed significantly, although marginally (P = .049). Cox models confirmed that 6MWD had no independent prognostic value for mortality (HR 0.98, 95% CI, 0.96-1.01, P = .26) or secondary outcomes. However, patients with < median 6MWD experienced higher rates of major bleeding (Incidence rate ratio (IRR) 2.88, P < .001), major infection (IRR 2.14, P < .0001), and renal dysfunction (IRR 4.78, P = .033). Conclusions: Shorter 6MWD 6 months after HM3 implantation was associated with a higher risk of some adverse events (AEs) but was not prognostic for mortality, HF recurrence, or rehospitalization risk. The prognostic value of 6MWD in HF patients without circulatory support cannot be extrapolated to patients treated with current left ventricular assist devices (LVADs). Clinical trial registration number: ClinicalTrials.gov Identifier: NCT02497950.
SN - 2753-670X
ER -