Predicting outcomes in pulmonary arterial hypertension based on the 6-minute walk distance
Predicting outcomes in pulmonary arterial hypertension based on the 6-minute walk distance
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DOI：
10.1016/j.healun.2014.08.020
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发表时间：
2015-03-01
影响因子：
8.9
通讯作者：
Benza, Raymond L.
中科院分区：
文献类型：
--
作者：
Farber, Harrison W.;Miller, Dave P.;Benza, Raymond L.
背景技术背景：肺动脉高压的临床研究已将6分钟步行距离（6 MWD）的变化作为临床终点;然而，其与生存结局的相关性尚未得到很好的确定。在这项分析中，我们检查了基线6 MWD的预后价值，6 MWD的绝对阈值，以及6 MWD的变化。方法：入选评估早期和长期肺动脉高压疾病管理（REVEAL）登记研究的患者，在入组时有6 MVVD，在观察的第一年内有或没有随访评估。对于基线6 MWD结果高于或低于所有可能阈值的子集，以及61 VIWD变化高于或低于所有可能阈值10个百分点的子集（包括改善阈值和恶化阈值），计算Kaplan-Meier生存估计值。多变量考克斯回归模型评估的效果改善和恶化的6 MWD对1年生存率，调整基线factors.RESULTS：一年生存率估计较高的基线6 MV TD高于与低于一个阈值的患者，虽然没有具体的阈值比另一个更预后。在一个模型调整的基线6 MWD和风险评分，恶化的6 MWD随着时间的推移显着预测生存率下降，但改善6 MWD并不影响survival.CONCLUSIONS：没有6 MWD改善阈值进行特定的预后价值。6 MWD的改善与生存率无关，但6 MWD的恶化与预后不良密切相关。(C)2015年国际心肺移植学会。All rights reserved.
BACKGROUND: Clinical studies of pulmonary arterial hypertension have used the change in the 6-minute walk distance (6MWD) as a clinical end point; however, its association with survival outcomes has not been well established. In this analysis, we examined the prognostic value of the baseline 6MWD, absolute thresholds of the 6MWD, and change in the 6MWD.METHODS: Patients in the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) with 6MVVD at enrollment, with or without a follow-up assessment within the first year of observation, were included. Kaplan-Meier survival estimates were computed for sub-sets with baseline 6MWD results that were above or below all possible thresholds and for sub-sets with a change in the 61VIWD that was 10 percentage points above or below all possible thresholds, including improvement thresholds and worsening thresholds. Multivariable Cox regression models assessed the effect of improvement and worsening in the 6MWD on 1-year survival, adjusted for baseline factors.RESULTS: One-year survival estimates were higher for patients with a baseline 6MV TD above vs below a threshold, although no specific threshold was more prognostic than another. In a model adjusted for the baseline 6MWD and risk score, worsening of the 6MWD over time significantly predicted decreased survival, but improvement in the 6MWD did not affect survival.CONCLUSIONS: No 6MWD improvement threshold carries particular prognostic value. Improvement in the 6MWD was not associated with survival, but worsening of the 6MWD was strongly and significantly associated with poor prognosis. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.