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  • Title: Submaximal exercise testing may be superior to the 6-min walk test in assessing pulmonary arterial hypertension disease severity.
    Author: Neal JE, Lee AS, Burger CD.
    Journal: Clin Respir J; 2014 Oct; 8(4):404-9. PubMed ID: 24308300.
    Abstract:
    INTRODUCTION: Submaximal exercise testing (SET) assesses functional exercise capacity in pulmonary arterial hypertension (PAH) patients and provides additional physiologic information compared with the 6-min walk test (6MWT). The relative correlations of the 6MWT and SET using SHAPE-HF™ with other markers of PAH severity, particularly echocardiogram (ECHO)-derived mean pulmonary artery pressure (MPAP), have not been investigated. OBJECTIVES: (i) Examine the correlation between SHAPE measures with the 6-min walk distance (6MWD), and (ii) Compare SHAPE parameters and the 6MWD to clinical measures of PAH severity. METHODS: Fifty-five consecutive group 1 PAH outpatients were evaluated in a single pulmonary hypertension referral center from March 2011 to June 2012. DATA COLLECTED: World Health Organization (WHO) functional class (FC), brain natriuretic peptide (BNP), ECHO, 6MWD and SHAPE results. Data are reported using mean ± standard deviation and Spearman correlation coefficients (r). RESULTS: Nine patients were excluded. Of the 46 remaining patients, 78% were women and the average age was 61 ± 13 years. PAH characteristics: WHO FC III-IV 48%; idiopathic PAH 52%; BNP 198 ± 277 pg/mL; 6MWD 399 ± 97 m; ECHO right atrial pressure (RAP) 7 ± 4, pulmonary artery systolic pressure (PASP) 63 ± 29 and MPAP 45 ± 17 mmHg. SET with SHAPE results: mean partial pressure of end-tidal (PET ) CO2 31 ± 6 mmHg at end-exercise; ventilatory efficiency (VE/VCO2 ) 43 ± 16. Significant correlations were found between the 6MWD and SHAPE variables: VE/VCO2 (r = -0.57, P < 0.0001) and end-exercise PET CO2 (r = 0.42, P = 0.004). VE/VCO2 correlated with WHO FC, BNP, RAP, MPAP and PASP and 6MWD only with WHO FC, BNP and PASP. CONCLUSION: SHAPE outperformed 6MWD in comparison with other measures of PAH disease severity.
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