Document Detail


Value of exercise treadmill testing in the risk stratification of patients with pulmonary hypertension.
MedLine Citation:
PMID:  19808350     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The ability of the Naughton-Balke exercise treadmill test, an objective indicator of exercise capacity, to predict abnormal hemodynamics and mortality in pulmonary hypertension is unknown. METHODS AND RESULTS: We performed a cohort study of 603 patients with pulmonary hypertension from 1982 to 2006, and studied the utility of exercise treadmill test as a predictor of abnormal hemodynamics and death. We used multivariable linear regression to determine whether exercise capacity, measured in metabolic equivalents, was associated with abnormal hemodynamics, and we used a Cox proportional hazards model to determine whether decreased exercise capacity predicted death. Mean age was 50+/-15 years, 76% were women, 63% had World Health Organization category I pulmonary arterial hypertension, and 23% were World Health Organization functional classes I and II. Mean exercise capacity was 3.7+/-2.2 metabolic equivalents. Decreased exercise capacity was independently associated with elevated right atrial and mean pulmonary artery pressure, decreased cardiac index, and increased pulmonary vascular resistance. During median follow-up of 4.6 years, 36% of the patients died. Decreased exercise capacity was associated with mortality (multivariable hazard ratio, 1.18; 95% CI, 1.01 to 1.37 for each 1-metabolic equivalent decrease in exercise capacity; P=0.031; P=0.052 after adjusting for invasive hemodynamic variables). Decreased exercise capacity also predicted mortality in functional classes I-II patients, 24% of whom died (hazard ratio, 1.53; 95% CI, 1.04 to 2.26 for each 1-metabolic equivalent decrease in exercise capacity; P=0.032), although this association did not persist after adjusting for invasive hemodynamic variables (P=0.63). CONCLUSIONS: Reduced exercise capacity on exercise treadmill test is associated with worse hemodynamics and is a predictor of mortality in patients with pulmonary hypertension.
Authors:
Sanjiv J Shah; Thenappan Thenappan; Stuart Rich; James Sur; Stephen L Archer; Mardi Gomberg-Maitland
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-05-13
Journal Detail:
Title:  Circulation. Heart failure     Volume:  2     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  278-86     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Exercise Test
Female
Humans
Hypertension, Pulmonary / diagnosis*,  mortality*
Male
Metabolic Equivalent*
Middle Aged
Predictive Value of Tests
Risk Assessment
Risk Factors
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
HL071115/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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