Early Decline in Six-Minute Walk Distance from the Time of Diagnosis Predicts Clinical Worsening in Pulmonary Arterial Hypertension
Early Decline in Six-Minute Walk Distance from the Time of Diagnosis Predicts Clinical Worsening in Pulmonary Arterial Hypertension
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DOI：
10.1159/000370124
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发表时间：
2015-01-01
期刊：
影响因子：
3.7
通讯作者：
Mura, Marco
中科院分区：
文献类型：
--
作者：
Huang, Julie;Mehta, Sanjay;Mura, Marco
背景：6分钟步行距离（6MWD）常用于评估肺动脉高压（PAH）。然而，6MWD在预测PAH结局方面的作用存在争议。临床恶化越来越多地被认为是PAH中有临床意义的终点。目的：我们旨在研究6MWD（Δ 6MWD）的早期纵向变化（单位：米）和自诊断时的预测百分比（%pred）是否可预测PAH的临床恶化。方法：回顾性分析100例I组PAH患者。使用美国（% pred US）或加拿大（%pred CAN）参考公式计算6MWD。记录6个月时的Δ 6MWD。临床恶化定义为：发生右心衰竭、因PAH住院、转诊接受肺移植或口服治疗失败后开始前列腺素类治疗。通过受试者工作特征（ROC）分析确定检测恶化的最佳6个月6MWD差异。结果：进展者（即临床恶化的患者）和非进展者在Delta 6MWD方面显示出显著差异。6个月时6MWD最具临床意义的下降为>= 35 m，>= 8%pred US和>= 6%pred CAN。ROC和考克斯比例风险分析显示6MWD % pred和meters的结果相当。6个月6MWD下降预测恶化，特异性高（94%），但敏感性低（33%）。结论：6MWD的早期下降（前6个月内）预测PAH未来的临床恶化具有高度特异性。Delta 6MWD仍可能是患者临床状态综合评估的一部分。然而，鉴于敏感性较差，应将6MWD的下降与其他临床工具一起使用，以适当评估PAH的进展。(C)2015 S. Karger AG，巴塞尔
Background: The six-minute walk distance (6MWD) is commonly used to assess pulmonary arterial hypertension (PAH). However, the role of 6MWD in predicting outcomes in PAH is controversial. Clinical worsening is being increasingly considered as a clinically meaningful end point in PAH. Objectives: We aimed to investigate whether early longitudinal changes in 6MWD (Delta 6MWD) in meters and percent predicted (%pred) from the time of diagnosis predict clinical worsening of PAH. Methods: One hundred patients with group I PAH were retrospectively assessed. 6MWD was calculated using American (% pred US) or Canadian (%pred CAN) reference equations. Delta 6MWD at 6 months were recorded. Clinical worsening was defined as either: development of right heart failure, hospital admission for PAH, referral for lung transplantation or initiation of prostanoids after oral therapy failed. Optimal 6-month differences in 6MWD to detect worsening were defined with receiver operating characteristics (ROC) analysis. Results: Progressors, i.e. patients with clinical worsening, and nonprogressors showed significant differences in Delta 6MWD. The most clinically significant declines in 6MWD at 6 months were >= 35 m, >= 8%pred US and >= 6%pred CAN. ROC and Cox proportional hazard analyses showed equivalent results for 6MWD % pred and meters. Six-month declines in 6MWD predicted worsening with a high specificity (94%) but a low sensitivity (33%). Conclusions: Early declines in 6MWD (within the first 6 months) predict future clinical worsening of PAH with high specificity. Delta 6MWD may still be part of a comprehensive assessment of a patient's clinical status. However, given the poor sensitivity, a decline in 6MWD should be used with other clinical tools to make an appropriate assessment of the progression of PAH. (C) 2015 S. Karger AG, Basel