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Fell B, Hanekom S, Heine M. A modified six-minute walk test (6MWT) for low-resource settings-a cross-sectional study. Heart Lung 2022; 52:117-122. [PMID: 35007887 DOI: 10.1016/j.hrtlng.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/10/2021] [Accepted: 12/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The 6 min walk test (6MWT) is a validated tool used to assess functional capacity in a variety of patient populations. Space constraints often limit the practicality of the 6MWT according to the standard (2002) American Thoracic Society protocol, and therefore, adaptations to this protocol are common with potential implications for research and clinical practice. Furthermore, such implications for research and clinical practice may be augmented in low-resourced settings. OBJECTIVES To determine the agreement between the 6 min walk distance (6MWD) achieved on the standard 30 m (6MWT30), and a straight 10 m (6MWT10), or 10 m figure-of-eight (6MWTF8) configuration, respectively. METHODS A cross-sectional study was conducted in a socioeconomic challenged community. A heterogeneous sample of adults (n = 27) with non-communicable disease were randomized into performing the 6MWT10 (n = 15) or 6MWTF8 (n = 12), in addition to the standard 6MWT30. Pairwise comparison and concordance correlation coefficients were used to assess agreement. RESULTS The mean (SD) 6MWD30 was 437(42) meters, while the mean 6MWD10 was 371(57). The mean difference (SE; p-value) between the 6MWD30 and 6MWD10 was 67 m (8.6; p .01). The mean 6MWD30 was 424(67) meters, while the mean 6MWDF8 was 347(58). The mean difference between the 6MWD30 and 6MWDF8 was 77 m (6.0; p .01). Moderate concordance was found between the 6MWT30 and 6MWTF8 or 6MWD10, respectively. CONCLUSIONS The present data suggest that, independent of configuration, using a shorter pathway significantly reduced the 6MWD. Low-resource settings may benefit from contemporary measures of functional capacity more conducive to resource constraints, or standardization of the test when used in such settings.
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Affiliation(s)
- Brittany Fell
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zyl Drive, Cape Town 8000, South Africa; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zyl Drive, Cape Town 8000, South Africa.
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2
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Billings CG, Lewis R, Hurdman JA, Condliffe R, Elliot CA, Thompson AR, Smith IA, Austin M, Armstrong IJ, Hamilton N, Charalampopoulos A, Sabroe I, Swift AJ, Rothman AM, Wild JM, Lawrie A, Waterhouse JC, Kiely DG. The incremental shuttle walk test predicts mortality in non-group 1 pulmonary hypertension: results from the ASPIRE Registry. Pulm Circ 2019; 9:2045894019848649. [PMID: 30997865 PMCID: PMC6542131 DOI: 10.1177/2045894019848649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/09/2019] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension (PH) is classified into five groups based on disease etiology but there is only limited information on the prognostic value of exercise testing in non-group 1 PH. In group 1 PH, the incremental shuttle walking test (ISWT) distance has been shown to correlate with pulmonary hemodynamics and predict survival without a ceiling effect. This study assessed the ISWT in non-group 1 PH. Data were retrieved from the ASPIRE Registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) for consecutive patients diagnosed with PH. Patients were required to have been systematically assessed as group 2-5 PH and to have a baseline ISWT within three months of cardiac catheterization. Patients were stratified according to incremental shuttle walk test distance (ISWD) and ISWT distance percent predicted (ISWD%pred). A total of 479 patients with non-group 1 PH were identified. ISWD and ISWD%pred correlated significantly with symptoms and hemodynamic severity. ISWD and ISWD%pred predicted survival with no ceiling effect. The test was prognostic in groups 2, 3, and 4. ISWD and ISWD%pred and change in ISWD and ISWD%pred at one year were all significant predictors of outcome. In patients with non-group 1 PH the ISWT is a simple non-invasive test that is easy to perform, is predictive of survival at baseline and follow-up, reflects change, and can be used in the assessment of PH of any etiology.
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Affiliation(s)
- Catherine G. Billings
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Robert Lewis
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Judith A. Hurdman
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Charlie A. Elliot
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - A.A. Roger Thompson
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Ian A. Smith
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Matthew Austin
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Iain J. Armstrong
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Neil Hamilton
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - Ian Sabroe
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
- Insigneo Institute for in
silico Medicine, University of Sheffield, The Pam Liversidge Building,
Sir Frederick Mappin Building, Sheffield, UK
| | - Alexander M. Rothman
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
- Insigneo Institute for in
silico Medicine, University of Sheffield, The Pam Liversidge Building,
Sir Frederick Mappin Building, Sheffield, UK
| | - Allan Lawrie
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Judith C. Waterhouse
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
| | - David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit,
Sheffield
Teaching Hospitals NHS Foundation Trust,
Royal
Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
- Insigneo Institute for in
silico Medicine, University of Sheffield, The Pam Liversidge Building,
Sir Frederick Mappin Building, Sheffield, UK
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3
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Hui M, Zhao J, Tian Z, Wang J, Qian J, Yang X, Wang Q, Li M, Zhao Y, Zeng X. Red blood cell distribution width as a potential predictor of survival of pulmonary arterial hypertension associated with primary Sjogren's syndrome: a retrospective cohort study. Clin Rheumatol 2018; 38:477-485. [PMID: 30218288 DOI: 10.1007/s10067-018-4281-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/26/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a severe complication and leading cause of mortality in patients with primary Sjogren's syndrome (pSS). This study was to investigate the overall survival rates and the utility of red blood cell distribution width (RDW) as a potential prognostic factor of pSS-PAH. This cohort study retrospectively enrolled 55 patients with pSS-PAH who were followed up at the Department of Rheumatology of Peking Union Medical College Hospital (PUMCH) between August 2007 and May 2017. The patients were stratified according to the level of RDW (≤ 15.0 and > 15.0%). Baseline demographics, laboratory results, pulmonary function conditions, hemodynamic assessments, and treatment regimens were analyzed. Cox proportional hazards regression analysis was used to identify whether RDW level is a factor related to adverse outcome. A total of 55 patients were recruited, with an average age of 38.9 ± 9.3 years. Fifty-four were female (98.2%), and the average duration at the time of PAH diagnosis was 25.5 ± 33.2 months. Higher RDW levels were found in patients who deceased in follow-up (13.8 ± 2.6 vs 16.5 ± 1.6%, p = 0.003) and with higher NYHA classes (13.8 ± 1.8 vs 16.5 ± 2.9%, p < 0.001). Patients with RDW > 15% had a significantly worse overall survival than patients with RDW ≤ 15% (3-year survival rate 59.5 vs. 88.7% log-rank p = 0.015). Cox regression analysis identified RDW > 15% as a prognostic factor for adverse outcome (HR 1.786, 95% CI 1.137-2.803, p = 0.012). RDW can serve as a potential negative prognostic factor of pSS-PAH.
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Affiliation(s)
- Min Hui
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Jieying Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Junyan Qian
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiaoxi Yang
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Schrover R, Evans K, Giugliani R, Noble I, Bhattacharya K. Minimal clinically important difference for the 6-min walk test: literature review and application to Morquio A syndrome. Orphanet J Rare Dis 2017; 12:78. [PMID: 28441951 PMCID: PMC5405472 DOI: 10.1186/s13023-017-0633-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
Morquio A syndrome is an ultra-rare, inherited lysosomal storage disorder associated with progressive, multi-systemic clinical impairments, causing gradual loss of functional capacity and endurance, impaired quality of life, and early mortality. Studies in Morquio A patients have used the 6-min walk test (6MWT) to assess functionality and endurance and to evaluate disease progression or efficacy of treatment. The objective of the present study was to review minimal clinically important differences (MCIDs) for the 6MWT reported for disease states that widely use the 6MWT to evaluate clinical benefit and to discuss the results in view of the challenges in estimating MCID for ultra-rare diseases, using the case of elosulfase alfa in Morquio A patients. A systematic literature search was performed using Embase and Medline to identify studies specifically estimating the MCID using either anchor-based or distribution-based methods. A total of 19 publications on 17 studies were identified; none of these included patients with Morquio A syndrome or the wider disease category of lysosomal storage disorders. Therefore, the MCIDs determined by studies in patients with respiratory, cardiovascular, or musculoskeletal disease were compared to changes in the 6MWT seen in Morquio A patients in the pivotal phase 3 clinical trial of elosulfase alfa enzyme replacement therapy. The literature review showed a mean MCID for the 6MWT of 7% change (range 3–15%) in studies using anchor-based methods and a 9% change (range 4–16%) using distribution-based methods. Results of the elosulfase alfa clinical trial and its extension showed a placebo-adjusted 14.9% improvement in the 6MWT from baseline at week 24, which was greater than the mean MCID based on the results of the systematic literature review. After 2 years, 6MWT distance increased by a mean of 20.7% from baseline in a modified per-protocol population, versus a reduction of 6.9% in comparable untreated patients from the MorCAP natural history study over the same period. Although further research is required to establish the MCID of the 6MWT in Morquio A patients, the presented data provide further evidence for the positive effect of elosulfase alfa in this patient population.
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Affiliation(s)
- Rudolf Schrover
- SYNEVi Pty Limited, Level 4, Suite 402, 15 Help Street, Chatswood, NSW 2067, Australia.
| | - Kathryn Evans
- BioMarin Pharmaceutical Australia Pty Ltd, Sydney, NSW, Australia
| | - Roberto Giugliani
- Medical Genetics Service/HCPA, Department of Genetics/UFRGS and INAGEMP, Porto Alegre, Brazil
| | - Ian Noble
- Noble Pharma Consulting, Sydney, NSW, Australia
| | - Kaustuv Bhattacharya
- Genetic Metabolic Disorders Service, Sydney Childrens' Hospital Network, Westmead, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney University, Sydney, NSW, Australia
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5
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Parry A, Higginson R, Gleeson A. End-of-life prognostic indicators in patients with COPD: part 2. Int J Palliat Nurs 2017; 22:560-567. [PMID: 27885911 DOI: 10.12968/ijpn.2016.22.11.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the UK, chronic respiratory diseases cause 13% of adult disability. The major chronic respiratory disease is chronic obstructive pulmonary disease (COPD), a condition involving chronic airway inflammation that causes airflow obstruction and destruction of lung tissue. This leads to a progressive loss of respiratory membrane, which accounts for the clinical manifestation of COPD, which is difficulty maintaining sufficient gas exchange to meet metabolic demands. The primary cause is smoking, with the vast majority of COPD patients having a past or present history of smoking. However, exposure to industrial pollutants is also a contributing factor, as is a rare genetic predisposition to developing COPD.
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Affiliation(s)
- Andy Parry
- Senior Lecturer in Critical Care, School of Care Sciences, Glyntaf Campus, University of South Wales
| | - Ray Higginson
- Senior Lecturer in Critical Care, School of Care Sciences, Glyntaf Campus, University of South Wales
| | - Aoife Gleeson
- Consultant in Palliative Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach
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6
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Gleeson A, Parry A, Higginson R. End-of-life prognostic indicators in patients with COPD: Part 1. Int J Palliat Nurs 2017; 22:508-514. [PMID: 27802088 DOI: 10.12968/ijpn.2016.22.10.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the UK, chronic respiratory diseases cause 13% of adult disability. The major chronic respiratory disease is chronic obstructive pulmonary disease (COPD), a condition involving chronic airway inflammation that causes airflow obstruction and destruction of lung tissue. This leads to a progressive loss of respiratory membrane, which accounts for the clinical manifestation of COPD, which is difficulty maintaining sufficient gas exchange to meet metabolic demands. The primary cause is smoking, with the vast majority of COPD patients having a past or present history of smoking. However exposure to industrial pollutants is also a contributing factor, as is a rare genetic predisposition to developing COPD.
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Affiliation(s)
- Aoife Gleeson
- Consultant in Palliative Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach
| | - Andy Parry
- Senior Lecturer in Critical Care School of Care Sciences Glyntaf Campus University of South Wales
| | - Ray Higginson
- Senior Lecturer in Critical Care School of Care Sciences Glyntaf Campus University of South Wales
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Statins Have No Additional Benefit for Pulmonary Hypertension: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2016; 11:e0168101. [PMID: 27992469 PMCID: PMC5167271 DOI: 10.1371/journal.pone.0168101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 11/24/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We performed a meta-analysis to explore the effects of adding statins to standard treatment on adult patients of pulmonary hypertension (PH). METHODS A systematic search up to December, 2015 of Medline, EMBASE, Cochrane Database of Systematic reviews and Cochrane Central Register of Controlled Trials was performed to identify randomized controlled trials with PH patients treated with statins. RESULTS Five studies involving 425 patients were included into this meta-analysis. The results of our analysis showed that the statins can't significantly increase 6-minute walking distance (6MWD, mean difference [MD] = -0.33 [CI: -18.25 to 17.59]), decrease the BORG dyspnea score (MD = -0.72 [CI: -2.28 to 0.85]), the clinical worsening risk (11% in statins vs. 10.1% in controls, Risk ratio = 1.06 [CI: 0.61, 1.83]), or the systolic pulmonary arterial pressure (SPAP) (MD = -0.72 [CI: -2.28 to 0.85]). Subgroup analysis for PH due to COPD or non-COPD also showed no significance. CONCLUSIONS Statins have no additional beneficial effect on standard therapy for PH, but the results from subgroup of PH due to COPD seem intriguing and further study with larger sample size and longer follow-up is suggested.
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Gong JN, Zhai ZG, Yang YH, Liu Y, Gu S, Kuang TG, Xie WM, Miao R, Wang C. Serum Bilirubin and 6-min Walk Distance as Prognostic Predictors for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Prospective Cohort Study. Chin Med J (Engl) 2016; 128:3125-31. [PMID: 26612283 PMCID: PMC4794865 DOI: 10.4103/0366-6999.170267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction. However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined. Our study aimed to evaluate the potential role of liver function markers (such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]) combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH. Methods: From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study. Baseline clinical characteristics and 6-min walk distance (6MWD) results were collected. Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment. All-cause mortality was recorded during the follow-up period. Results: During the follow-up, 22 patients (29%) died. Cox regression analyses demonstrated that increased serum concentration of total bilirubin (hazard ratio [HR] = 7.755, P < 0.001), elevated N-terminal of the prohormone brain natriuretic peptide (HR = 1.001, P = 0.001), decreased 6MWD (HR = 0.990, P < 0.001), increased central venous pressure (HR = 1.074, P = 0.040), and higher pulmonary vascular resistance (HR = 1.001, P = 0.018) were associated with an increased risk of mortality. Serum concentrations of total bilirubin (HR = 4.755, P = 0.007) and 6MWD (HR = 0.994, P = 0.017) were independent prognostic predictors for CTEPH patients. Patients with hyperbilirubinemia (≥23.7 μmol/L) had markedly worse survival than those with normobilirubinemia. Conclusion: Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chen Wang
- Department of Respiratory Medicine, Capital Medical University, Beijing 100069; China Japan Friendship Hospital, National Clinical Research Center of Respiratory Medicine, Beijing 100029, China
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Buys R, Avila A, Cornelissen VA. Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials. BMC Pulm Med 2015; 15:40. [PMID: 25896259 PMCID: PMC4423624 DOI: 10.1186/s12890-015-0031-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by hypertension in the pulmonary arteries. PAH leads to symptoms such as shortness of breath, dizziness, leg edema and chest pain, impacting heavily on quality of life. The aim of this systematic review and meta-analysis was to determine the effect of exercise training to improve physical fitness and functionality in patients with PAH. METHODS A search was conducted for controlled trials using the databases Medline, Embase, SPORT Discus and Cochrane Central Register of Controlled Trials. Studies were included if at least 80% of the participants presented with group 1 PAH and if the intervention consisted of an exercise training program of at least 3 weeks duration. Data were extracted on study quality, participant and exercise intervention characteristics, and outcomes. Data were pooled by the generic inverse variance method using random effect models and were expressed as weighted means and 95% confidence intervals (CI). RESULTS Of 110 identified abstracts, 5 studies with 106 patients (exercise: 53; control: 53; mean age 49.7 years) were included. Disease severity ranged from mild to severe; 96 patients suffered from PAH, 10 patients had chronic thromboembolic pulmonary hypertension. Exercise training led to an increase in 6 minute walk distance (72.5 m; 95% CI 46.0 m to 99.1 m; p < 0.0001) and peak oxygen uptake (2.16 mL/kg/min; 95% CI 2.16 to 3.93; p = 0.02). No severe adverse events during exercise were reported. CONCLUSIONS Our findings suggest that an exercise training program positively influences exercise tolerance and functional capacity in patients with PAH.
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Affiliation(s)
- Roselien Buys
- Department of Rehabilitation Sciences, Tervuursevest 101, B 1501, B-3001, Leuven, Belgium.
| | - Andrea Avila
- Department of Rehabilitation Sciences, Tervuursevest 101, B 1501, B-3001, Leuven, Belgium.
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Pulmonary hypertension and right heart dysfunction in chronic lung disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:739674. [PMID: 25165714 PMCID: PMC4140123 DOI: 10.1155/2014/739674] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/24/2014] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
Group 3 pulmonary hypertension (PH) is a common complication of chronic lung disease (CLD), including chronic obstructive pulmonary disease (COPD), interstitial lung disease, and sleep-disordered breathing. Development of PH is associated with poor prognosis and may progress to right heart failure, however, in the majority of the patients with CLD, PH is mild to moderate and only a small number of patients develop severe PH. The pathophysiology of PH in CLD is multifactorial and includes hypoxic pulmonary vasoconstriction, pulmonary vascular remodeling, small vessel destruction, and fibrosis. The effects of PH on the right ventricle (RV) range between early RV remodeling, hypertrophy, dilatation, and eventual failure with associated increased mortality. The golden standard for diagnosis of PH is right heart catheterization, however, evidence of PH can be appreciated on clinical examination, serology, radiological imaging, and Doppler echocardiography. Treatment of PH in CLD focuses on management of the underlying lung disorder and hypoxia. There is, however, limited evidence to suggest that PH-specific vasodilators such as phosphodiesterase-type 5 inhibitors, endothelin receptor antagonists, and prostanoids may have a role in the treatment of patients with CLD and moderate-to-severe PH.
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