Document Detail


A pulmonary hypertension gas exchange severity (PH-GXS) score to assist with the assessment and monitoring of pulmonary arterial hypertension.
MedLine Citation:
PMID:  22245407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Submaximal exercise gas analysis may be a useful method to assess and track pulmonary arterial hypertension (PAH) severity. The aim of the present study was to develop an algorithm, using exercise gas exchange data, to assess and monitor PAH severity. Forty patients with PAH participated in the study, completing a range of clinical tests and a novel submaximal exercise step test, which lasted 6 minutes and incorporated rest (2 minutes), exercise (3 minutes), and recovery (1 minute) ventilatory gas analysis. Using gas exchange data, including breathing efficiency, end-tidal carbon dioxide, oxygen saturation, and oxygen pulse, a pulmonary hypertension gas exchange severity (PH-GXS) score was developed. Patients were retested after about 6 months. There was significant separation between healthy controls and patients with moderate PAH (World Health Organization [WHO] class I/II) and those with more severe PAH (WHO class III/IV) for breathing efficiency, end-tidal carbon dioxide, oxygen saturation, and oxygen pulse. The PH-GXS score was significantly correlated with WHO class (r = 0.51), 6-minute walking distance (r = -0.59), right ventricular systolic pressure (r = 0.49), log N-terminal pro-B-type natriuretic peptide (r = 0.54), and pulmonary vascular resistance (r = 0.71). The PH-GXS score remained unchanged in 22 patients retested (1.50 ± 0.92 vs 1.48 ± 0.94), as did WHO class (2.3 ± 0.8 vs 2.3 ± 0.8) and 6-minute walking distance (455 ± 120 vs 456 ± 103 m). Small individual changes were observed in the PH-GXS score, with 8 patients improving and 8 deteriorating. In conclusion, the PH-GXS score differentiated between patients with PAH and was correlated with traditional clinical measures. The PH-GXS score was unchanged in our cohort after 6 months, consistent with traditional clinical metrics, but individual differences were evident. A PH-GXS score may be a useful way to track patient responses to therapy.
Authors:
Paul R Woods; Bryan J Taylor; Robert P Frantz; Bruce D Johnson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-01-14
Journal Detail:
Title:  The American journal of cardiology     Volume:  109     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-26     Completed Date:  2012-05-18     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1066-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Algorithms
Antihypertensive Agents / therapeutic use
Biological Markers / blood
Carbon Dioxide / blood*
Case-Control Studies
Cohort Studies
Drug Therapy, Combination
Epoprostenol / therapeutic use
Exercise Test*
Female
Humans
Hypertension, Pulmonary / blood*,  diagnosis*,  drug therapy,  physiopathology
Male
Middle Aged
Natriuretic Peptide, Brain / blood
Oxygen / blood*
Phosphodiesterase 5 Inhibitors / therapeutic use
Pulmonary Gas Exchange*
Receptors, Endothelin / antagonists & inhibitors
Risk Assessment
Severity of Illness Index
Treatment Outcome
Walking
Grant Support
ID/Acronym/Agency:
HL71478/HL/NHLBI NIH HHS; R01 HL071478/HL/NHLBI NIH HHS; R01 HL071478-01/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Biological Markers; 0/Phosphodiesterase 5 Inhibitors; 0/Receptors, Endothelin; 114471-18-0/Natriuretic Peptide, Brain; 142M471B3J/Carbon Dioxide; DCR9Z582X0/Epoprostenol; S88TT14065/Oxygen
Comments/Corrections

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