Document Detail


Heart rate recovery after 6-min walk test predicts survival in patients with idiopathic pulmonary fibrosis.
MedLine Citation:
PMID:  19395579     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with idiopathic pulmonary fibrosis (IPF), our objectives were to identify predictors of abnormal heart rate recovery (HRR) at 1 min after completion of a 6-min walk test (6MWT) [HRR1] and 2 min after completion of a 6MWT (HRR2), and to determine whether abnormal HRR predicts mortality.
METHODS: From 2003 to 2008, we identified IPF patients who had been evaluated at our center (n = 76) with a pulmonary physiologic examination and the 6MWT. We used logistic regression to identify predictors of abnormal HRR, the product-limit method to compare survival in the sample stratified on HRR, and Cox proportional hazards analysis to estimate the prognostic capability of abnormal HRR.
RESULTS: Cutoff values were 13 beats for abnormal HRR1 and 22 beats for HRR2. In a multivariable model, predictors of abnormal HRR1 were diffusing capacity of the lung for carbon monoxide (odds ratio [OR], 0.4 per 10% predicted; 95% confidence interval [CI], 0.2 to 0.7; p = 0.003), change in heart rate from baseline to maximum (OR, 0.9; 95% CI, 0.8 to 0.97; p = 0.01), and having a right ventricular systolic pressure > 35 mm Hg as determined by transthoracic echocardiogram (OR, 12.7; 95% CI, 2.0 to 79.7; p = 0.01). Subjects with an abnormal HRR had significantly worse survival than subjects with a normal HRR (for HRR1, p = 0.0007 [log-rank test]; for HRR2, p = 0.03 [log-rank test]); these results held for the subgroup of 30 subjects without resting pulmonary hypertension (HRR1, p = 0.04 [log-rank test]). Among several candidate variables, abnormal HRR1 appeared to be the most potent predictor of mortality (hazard ratio, 5.2; 95% CI, 1.8 to 15.2; p = 0.004).
CONCLUSION: Abnormal HRR after 6MWT predicts mortality in IPF patients. Research is needed to confirm these findings prospectively and to examine the mechanisms of HRR in IPF patients.
Authors:
Jeffrey J Swigris; Jeff Swick; Frederick S Wamboldt; David Sprunger; Roland du Bois; Aryeh Fischer; Gregory P Cosgrove; Stephen K Frankel; Evans R Fernandez-Perez; Dolly Kervitsky; Kevin K Brown
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-04-24
Journal Detail:
Title:  Chest     Volume:  136     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-08     Completed Date:  2009-10-08     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  841-8     Citation Subset:  AIM; IM    
Affiliation:
Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, Denver, CO 80206, USA. swigrisj@njc.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Chi-Square Distribution
Exercise Test
Female
Heart Rate / physiology*
Humans
Idiopathic Pulmonary Fibrosis / mortality*,  physiopathology*
Logistic Models
Male
Oximetry
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Survival Rate
Walking / physiology*
Grant Support
ID/Acronym/Agency:
HL67671/HL/NHLBI NIH HHS; K23 HL092227/HL/NHLBI NIH HHS
Comments/Corrections

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