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Lachant DJ, Lachant MD, Haight D, White RJ. Cardiac effort and 6-min walk distance correlate with stroke volume measured by cardiac magnetic resonance imaging. Pulm Circ 2024; 14:e12355. [PMID: 38572082 PMCID: PMC10985409 DOI: 10.1002/pul2.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
Right ventricular (RV) dysfunction in pulmonary arterial hypertension (PAH) is associated with poor outcomes. Cardiac magnetic resonance imaging (cMRI) is the gold standard for volumetric assessment, and few reports have correlated 6-min walk distance (6MWD) and cMRI parameters in PAH. Cardiac Effort, (the number of heart beats used during 6-min walk test)/(6MWD), incorporates physiologic changes into walk distance and has been associated with stroke volume (SV) measured by nuclear imaging and indirect Fick. Here, we aimed to interrogate the relationship of Cardiac Effort and 6MWD with SV measured by the gold standard, cMRI. This was a single-center, observational, prospective study in Group 1 PAH patients. Subjects completed 6-min walk with heart rate monitoring (Cardiac Effort) and cMRI within 24 h. cMRI was correlated to Cardiac Effort and 6MWD using Spearman Correlation Coefficient. Twenty-five participants with a wide range of RV function completed both cMRI and Cardiac Effort. There was a strong correlation between left ventricle SV index and both Cardiac Effort (r = -0.70, p = 0.0001) and 6MWD (r = 0.67, p = 0.0002). Cardiac Effort and 6MWD were statistically separated in patients at prognostically significant thresholds of left ventricle SV index (>31 ml/m2), RV Ejection Fraction (>35%), and SV/End Systolic Volume ( > 0.53). Cardiac Effort and 6MWD are noninvasive ways to gain insight into those with impaired SV. 6MWD may correlate better with SV than previously thought and heart rate monitoring provides physiologic context to the walk distance obtained.
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Affiliation(s)
- Daniel J. Lachant
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRocesterNYUSA
| | - Michael D. Lachant
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRocesterNYUSA
| | - Deborah Haight
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRocesterNYUSA
| | - R. James White
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRocesterNYUSA
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Lachant D, Light A, Lachant M, Annis J, Hemnes A, Brittain E, White RJ. Peak steps: Capacity for activity improves after adding approved therapy in pulmonary arterial hypertension. Pulm Circ 2023; 13:e12285. [PMID: 37701142 PMCID: PMC10493080 DOI: 10.1002/pul2.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) patients have low activity. Activity intensity or duration could be a measure of clinical status or improvement. We aimed to determine whether standard or novel actigraphy measures could detect increases in activity after adding therapy. This was a prospective, single-center observational study evaluating activity after adding therapy in Group 1 PAH; we also report a validation cohort. For our study, two different accelerometers were used, a wrist (ActiGraph) and chest (MC10) device. Patients were analyzed in two groups, Treatment Intensification (TI, adding therapy) or Stable. Both groups had baseline monitoring periods of 7 days; the TI group had follow-up at 3 months, while Stables had follow-up within 4 weeks to assess stability. Activity time and steps were reported from both devices' proprietary algorithms. In ActiGraph only, steps in 1-min intervals throughout the day were ranked (not necessarily contiguous). Average values for each week were calculated and compared using nonparametric testing. Thirty patients had paired data (11 Stable and 19 TI). There was no between-group difference at baseline; we did not observe therapy-associated changes on average daily steps or activity time/intensity. The top 5 min of steps (capacity) increased after adding therapy; there was no difference in the stable group. This key finding was validated in a previously reported randomized trial studying a behavioral intervention to increase exercise. Total daily activity metrics are influenced by both disease and non-disease factors, making therapy-associated change difficult to detect. Peak minute steps were a treatment-responsive marker in both a pharmacologic and training intervention.
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Affiliation(s)
- Daniel Lachant
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Allison Light
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michael Lachant
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Jeffrey Annis
- Department of Medicine, Division of CardiologyVanderbilt UniversityNashvilleTennesseeUSA
| | - Anna Hemnes
- Division of Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt UniversityNashvilleTennesseeUSA
| | - Evan Brittain
- Department of Medicine, Division of CardiologyVanderbilt UniversityNashvilleTennesseeUSA
| | - R. James White
- Department of Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Cardiopulmonary Exercise Testing in Pulmonary Arterial Hypertension. Heart Fail Clin 2023; 19:35-43. [DOI: 10.1016/j.hfc.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lachant D, Kennedy E, Derenze B, Light A, Lachant M, White RJ. Cardiac Effort to Compare Clinic and Remote 6-Minute Walk Testing in Pulmonary Arterial Hypertension. Chest 2022; 162:1340-1348. [PMID: 35777448 PMCID: PMC9238055 DOI: 10.1016/j.chest.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has limited objective physiologic assessments. A standardized remote alternative is not currently available. "Cardiac effort" (CE), that is, the total number of heart beats divided by the 6-min walk test (6MWT) distance (beats/m), has improved reproducibility in the 6MWT and correlated with right ventricular function in pulmonary arterial hypertension. RESEARCH QUESTION Can a chest-based accelerometer estimate 6MWT distance remotely? Is remote cardiac effort more reproducible than 6MWT distance when compared with clinic assessment? STUDY DESIGN AND METHODS This was a single-center, prospective observational study, with institutional review board approval, completed between October 2020 and April 2021. Group 1 subjects with pulmonary arterial hypertension, receiving stable therapy for > 90 days, completed four to six total 6MWTs during a 2-week period to assess reproducibility. The first and last 6MWTs were performed in the clinic; two to four remote 6MWTs were completed at each participant's discretion. Masks were not worn. BioStamp nPoint sensors (MC10) were worn on the chest to measure heart rate and accelerometry. Two blinded readers counted laps, using accelerometry data obtained on the clinic or user-defined course. Averages of clinic variables and remote variables were used for Wilcoxon matched-pairs signed rank tests, Bland-Altman plots, or Spearman correlation coefficients. RESULTS Estimated 6MWT distance, using the MC10, correlated strongly with directly measured 6MWT distance (r = 0.99; P < .0001; in 20 subjects). Remote 6MWT distances were shorter than clinic 6MWT distances: 405 m (330-464 m) vs 389 m (312-430 m) (P = .002). There was no difference between in-clinic and remote CE: 1.75 beats/m (1.48-2.20 beats/m) vs 1.86 beats/m (1.57-2.14 beats/m) (P = .14). INTERPRETATION Remote 6MWT was feasible on a user-defined course; 6MWT distance was shorter than clinic distance. CE calculated by chest heart rate and accelerometer-estimated distance provides a reproducible remote assessment of exercise tolerance, comparable to the clinic-measured value.
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Affiliation(s)
- Daniel Lachant
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY,CORRESPONDENCE TO: Daniel Lachant, DO
| | - Ethan Kennedy
- University of New England College of Osteopathic Medicine, Biddeford, ME
| | | | - Allison Light
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY
| | - Michael Lachant
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY
| | - R. James White
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY
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Frantz RP, Benza RL, Channick RN, Chin K, Howard LS, McLaughlin VV, Sitbon O, Zamanian RT, Hemnes AR, Cravets M, Bruey JM, Roscigno R, Mottola D, Elman E, Zisman LS, Ghofrani HA. TORREY, a Phase 2 study to evaluate the efficacy and safety of inhaled seralutinib for the treatment of pulmonary arterial hypertension. Pulm Circ 2021; 11:20458940211057071. [PMID: 34790348 PMCID: PMC8591655 DOI: 10.1177/20458940211057071] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022] Open
Abstract
Aberrant kinase signaling that involves platelet-derived growth factor receptor (PDGFR) α/β, colony stimulating factor 1 receptor (CSF1R), and stem cell factor receptor (c-KIT) pathways may be responsible for vascular remodeling in pulmonary arterial hypertension. Targeting these specific pathways may potentially reverse the pathological inflammation, cellular proliferation, and fibrosis associated with pulmonary arterial hypertension progression. Seralutinib (formerly known as GB002) is a novel, potent, clinical stage inhibitor of PDGFRα/β, CSF1R, and c-KIT delivered via inhalation that is being developed for patients with pulmonary arterial hypertension. Here, we report on an ongoing Phase 2 randomized, double-blind, placebo-controlled trial (NCT04456998) evaluating the efficacy and safety of seralutinib in subjects with World Health Organization Group 1 Pulmonary Hypertension who are classified as Functional Class II or III. A total of 80 subjects will be enrolled and randomized to receive either study drug or placebo for 24 weeks followed by an optional 72-week open-label extension study. The primary endpoint is the change from baseline to Week 24 in pulmonary vascular resistance by right heart catheterization. The secondary endpoint is the change in distance from baseline to Week 24 achieved in the 6-min walk test. A computerized tomography sub-study will examine the effect of seralutinib on pulmonary vascular remodelling. A separate heart rate monitoring sub-study will examine the effect of seralutinib on cardiac effort during the 6-min walk test.
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Affiliation(s)
| | | | | | - Kelly Chin
- UT Southwestern Medical Center, Dallas, TX, USA
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Lachant D, Light A, Hannon K, Abbas F, Lachant M, White RJ. Comparison of chest- and wrist-based actigraphy in pulmonary arterial hypertension. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 3:90-97. [PMID: 36713990 PMCID: PMC9707912 DOI: 10.1093/ehjdh/ztab095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 02/01/2023]
Abstract
Aims Activity trackers for clinical trials and remote monitoring are appealing as they provide objective data outside of the clinic setting. Algorithms determine physical activity intensity and count steps. Multiple studies show physical inactivity in pulmonary arterial hypertension (PAH). There are no studies comparing different activity trackers worn on different parts of the body in PAH. We had patients with PAH simultaneously wear two different accelerometers, compared measures between the two devices, and correlated the measures with standard clinical metrics in PAH. Methods and results This was a single-centre, prospective observational study. Daily physical activity and daily total steps were measured using Actigraph GT9X Link and MC10 Biostamp nPoint for 5-10 days. Actigraph was worn on the non-dominant hand and the MC10 Biostamp nPoint was worn on the chest and leg with disposable adhesives. Twenty-two participants wore both accelerometers >12 h/day for an average 7.8 days. The average activity time measured by Actigraph was significantly higher than that measured by MC10 (251 ± 25 min vs. 113 ± 18 min, P = 0.0001). Actigraph's algorithm reported more time in light activity than moderate (190 ± 62 min vs. 60 ± 56 min, P = 0.0001). REVEAL 2.0 scores correlated highly with activity time measured using either device. Invasively measured haemodynamics within 7 days did not correlate with activity time or daily steps. Conclusion Different activity trackers yield discordant results in PAH patients. Further studies are needed in determining the best device, optimal wear time, and different thresholds for activities in chronic diseases.
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Affiliation(s)
| | - Allison Light
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 692, Rochester, NY 14620, USA
| | - Kevin Hannon
- Department of Internal Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14620, USA
| | - Farrukh Abbas
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 692, Rochester, NY 14620, USA
| | - Michael Lachant
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 692, Rochester, NY 14620, USA
| | - R James White
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Box 692, Rochester, NY 14620, USA
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Roto D, Lachant NA, James White R, Lachant DJ. Resting heart rate as a surrogate for improvement in intermediate risk pulmonary embolus patients? Respir Med 2021; 187:106578. [PMID: 34416617 DOI: 10.1016/j.rmed.2021.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/19/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) response teams (PERT) have been developed to improve in-hospital mortality. Identifying intermediate risk PE patients that will progress despite anticoagulation is difficult, especially because outcomes with modern anticoagulation are quite good. OBJECTIVE The primary aim of this study was to evaluate the rate of anticoagulation failure (new deep vein thrombosis or PE, right ventricular failure resulting in shock, cardiac arrest, or PE-attributable death) in intermediate risk PE patients managed by PERT. The secondary objective was to determine whether there was a significant decrease in heart rate 24 h after initiation of anticoagulation in intermediate risk PE. METHODS This was a retrospective observational study of patients treated for acute intermediate risk PE at the University of Rochester Medical Center who also had outpatient followup between November 2016-June 2019. RESULTS Ninety-two patients presented as intermediate-risk PE and had outpatient followup. Seventy-four patients were initially treated with anticoagulation. None of these patients failed anticoagulation. Of the eighteen intermediate risk patients that underwent advanced intervention, none failed anticoagulation first. There was significant decrease in resting heart rate 24 h after starting therapeutic anticoagulation, 107 beats/min vs 89 beats/min, p = 0.0001. CONCLUSION We did not observe anticoagulation failure in the management of acute, intermediate risk PE. Reductions in heart rate may reflect improvements in right ventricular function; we hypothesize that those whose heart rate does not fall may be optimal candidates for advanced intervention.
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Affiliation(s)
- Dominick Roto
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Neil A Lachant
- Division of Hematology at the Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - R James White
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel J Lachant
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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