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We evaluated the clinical utility of the 6MWD by quantifying the gap between the expected and observed physical performance and estimating its determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Outpatients with wild-type (ATTRwt)-CM were investigated. Standardized echocardiographic, laboratory and clinical assessments were performed. A regression formula derived from a healthy local population sample was applied to predict the expected 6MWD. Associations with 6MWD were analyzed by linear regression, adjusted for age and height. Explanatory multivariable models using backward elimination, regularization and clinical reasoning were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>100 patients were analyzed. Their mean age was 78.7 (6.3) years and 86% were men. The mean observed 6MWD was 310 (113) m, which corresponded to about 65% of the expected performance. Significant predictors of the 6MWD were (ordered by decreasing explanatory power): high-sensitivity Troponin T, NT-proBNP, NAC disease stage, estimated glomerular filtration rate, atrial fibrillation, hemoglobin, hepatic vein dilation, mitral E-wave maximum velocity, left ventricular ejection fraction, and the tricuspid valve maximal regurgitation pressure gradient. Multivariable models yielded an R\u00b2 of up to 45.9% with a root mean squared error of 82.9\u00a0m.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Physical performance as measured by the 6MWD in patients with ATTRwt-CM was remarkably compromised. Laboratory and imaging markers indicative of disease severity and congestion predicted the 6MWD in these patients. Cardiovascular markers explained a fair amount of 6MWD variability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-025-05215-4","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T15:55:29Z","timestamp":1763135729000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular determinants of the 6-minute walk distance in cardiac transthyretin amyloidosis"],"prefix":"10.1186","volume":"25","author":[{"given":"Vladimir","family":"Cejka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens","family":"Hosp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Steinhardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aikaterini","family":"Papagianni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Ihne-Schubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Scholz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengmeng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Adrah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Kort\u00fcm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermann","family":"Einsele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Frantz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"St\u00f6rk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Morbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"issue":"1","key":"5215_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1161\/CIRCULATIONAHA.118.038169","volume":"140","author":"T Lane","year":"2019","unstructured":"Lane T, Fontana M, Martinez-Naharro A, et al. 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Cejka received financial support for attendance of scientific congresses from Boehringer Ingelheim, Lili, Alnylam, including travel and accommodation support, and speaker honoraria from Pfizer.S. Ihne-Schubert received financial reimbursement for consulting, advisory board activities, speaker honoraries and\/or travel support to attend scientific meetings by Akcea Therapeutics, Alnylam, Pfizer, Janssen-Cilag, and Takeda, and further research funding from Pfizer and Akcea Therapeutics. An internship was supported by ONLUS. She was fellow of the local Clinician Scientist program of the IZKF W\u00fcrzburg.S. St\u00f6rk is supported by the Comprehensive Heart Failure Center inW\u00fcrzburg, and by the German Federal Ministry of Education and Research (BMBF). He has received consultancy and lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, NovoNordisk, Pfizer. He is investigator in trials sponsored by Alnylam, Akcea, IONIS, NovoNordisk.C. Morbach reports research cooperation with the University of W\u00fcrzburg and Tomtec Imaging Systems funded by a research grant from the Bavarian Ministry of Economic Affairs, Regional Development and Energy, Germany; she is supported by the German Research Foundation (DFG) within the Comprehensive Research Center 1525 \u2018Cardio-immune interfaces\u2019 (453989101, project C5) and receives financial support from the Interdisciplinary Center for Clinical Research - IZKF W\u00fcrzburg (advanced clinician-scientist program; AdvCSP 3). She further received advisory and speakers honoraria as well as travel grants from Tomtec, Alnylam, Akcea, Pfizer, Boehringer Ingelheim, SOBI, AstraZeneca, NovoNordisk, Alexion, Janssen, and EBR Systems; principal investigator in trials sponsored by Alnylam, Bayer, NovoNordisk, and AstraZeneca.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"810"}}