Physical activity in incident patients with pulmonary arterial and chronic thromboembolic hypertension
Physical activity in incident patients with pulmonary arterial and chronic thromboembolic hypertension
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DOI：
10.1007/s00408-019-00248-x
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发表时间：
2019-10-01
期刊：
影响因子：
5
通讯作者：
Ulrich, Silvia
中科院分区：
文献类型：
--
作者：
Saxer, Stephanie;Lichtblau, Mona;Ulrich, Silvia
介绍肺动脉高压（PH）的主要症状是劳力性呼吸困难，导致日常生活活动减少。本研究的目的是分析动脉或慢性血栓栓塞性PH（PAH/CTEPH）患者的日常体力活动，并研究其与肺血流动力学、症状、运动能力和其他结局的相关性。方法PAH/CTEPH突发患者在诊断性右心导管插入术（RHC）后-3个月/+2周内通过臂戴式加速度计SenseWear进行1周活动评估，基线评估包括6分钟步行距离（6 MWD）。活动与休息和运动时的RHC数据以及其他结果相关。结果39例PH患者（PAH 24例，CTEPH 15例，女性23例，年龄65（54;73）岁，平均肺动脉压（mPAP）38（30;46）mmHg，心输出量（CO）5.2（4.6;6.3）l/min，6 MWD 458（300;593）m）。64%的人有久坐的生活方式（< 5000步/天），26%的人中度活跃（5000-9999步/天），10%的人活跃。在包括年龄、性别、6 MWD和静息和运动时血流动力学（心率、mPAP、每搏输出量）的多变量逐步回归分析中，6 MWD是步数/天的唯一独立预测因子（B = 16.8（95% CI 11.6-22.0），p < 0.001）。结论：PAH/CTEPH患者的每日体力活动（步数/天）与静息或运动时的有创血流动力学相关性不好，但与6 MWD相关性很好。在PAH/CTEPH患者随访期间，日常活动评估是否提供了简单步行距离的风险因素特征的额外信息仍有待澄清。
Introduction The cardinal symptom of pulmonary hypertension (PH) is dyspnea on exertion, leading to decreased activity in daily living. The aim of this study was to analyze daily physical activity in incident patients with arterial or chronic thromboembolic PH (PAH/CTEPH) and to investigate its correlation with pulmonary hemodynamics, symptoms, exercise capacity, and other outcomes. Methods Incident patients with PAH/CTEPH had a 1-week activity assessment by the arm-worn accelerometer SenseWear within - 3 months/+ 2 weeks of the diagnostic right heart catheterization (RHC) and baseline assessments including 6-minute walking distance (6MWD). Activity was correlated to RHC data at rest and exercise and to other outcomes. Results Thirty-nine PH-patients (24 PAH, 15 CTEPH, 23 females, 65(54;73) years, mean pulmonary artery pressure (mPAP) 38(30;46) mmHg, cardiac output (CO) 5.2(4.6;6.3) l/min, 6MWD 458(300;593) m) were included. 64% had a sedentary lifestyle ( < 5000 steps/day), 26% were moderately active (5000-9999 steps/day), and 10% were active. In a multivariate stepwise regression analysis including age, gender, 6MWD and hemodynamics at rest and during exercise (heart rate, mPAP, stroke volume), the 6MWD was the only independent predictor of steps/day (B = 16.8 (95% CI 11.6-22.0), p < 0.001). Conclusion Daily physical activity as steps/day assessed in incident patients with PAH/CTEPH did not well correlate with invasive hemodynamics at rest or during exercise, but very well with the 6MWD. Whether daily activity assessments provide additional information to simple walk distance on risk factor profiles during follow-up in patients with PAH/CTEPH remains to be clarified.