Catherine G Billings1, Judith A Hurdman1, Robin Condliffe1, Charlie A Elliot1, Ian A Smith1, Matthew Austin1, Iain J Armstrong1, Neil Hamilton1, Athanasios Charalampopoulos1, Ian Sabroe2, Andrew J Swift3, Alexander M Rothman4, Jim M Wild3, Allan Lawrie4, Judith C Waterhouse1, David G Kiely5. 1. Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield. 2. Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield. 3. Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield; Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom. 4. Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield. 5. Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield; Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom. Electronic address: David.kiely@sth.nhs.uk.
Abstract
BACKGROUND: To ensure effective monitoring of pulmonary arterial hypertension (PAH), a simple, reliable assessment of exercise capacity applicable over a range of disease severity is needed. The aim of this study was to assess the ability of the incremental shuttle walk test (ISWT) to correlate with disease severity, measure sensitivity to change, and predict survival in PAH. METHODS: We enrolled 418 treatment-naïve patients with PAH with baseline ISWT within 3 months of cardiac catheterization. Clinical validity and prognostic value of ISWT distance were assessed at baseline and 1 year. RESULTS: ISWT distance was found to correlate at baseline with World Health Organization functional class, Borg score, and hemodynamics without a ceiling effect (all p < 0.001). Walking distance at baseline and after treatment predicted survival; the area under the receiver operating characteristic curve for ability of ISWT distance to predict mortality was 0.655 (95% confidence interval 0.553-0.757; p = 0.004) at baseline and 0.737 (95% confidence interval 0.643-0.827; p < 0.001) at 1 year after initiation of treatment. Change in ISWT distance also predicted survival (p = 0.04). Heart rate (HR) and systolic blood pressure (SBP) parameters reflecting autonomic response to exercise (highest HR, change in HR, HR recovery at 1 minute >18 beats/min, highest SBP, change in SBP, and 3-minute SBP ratio) were significant predictors of survival (all p < 0.05). CONCLUSIONS: In patients with PAH, the ISWT is simple to perform, allows assessment of maximal exercise capacity, is sensitive to treatment effect, predicts outcome, and has no ceiling effect. Also, measures of autonomic function made post-exercise predict survival in PAH.
BACKGROUND: To ensure effective monitoring of pulmonary arterial hypertension (PAH), a simple, reliable assessment of exercise capacity applicable over a range of disease severity is needed. The aim of this study was to assess the ability of the incremental shuttle walk test (ISWT) to correlate with disease severity, measure sensitivity to change, and predict survival in PAH. METHODS: We enrolled 418 treatment-naïve patients with PAH with baseline ISWT within 3 months of cardiac catheterization. Clinical validity and prognostic value of ISWT distance were assessed at baseline and 1 year. RESULTS: ISWT distance was found to correlate at baseline with World Health Organization functional class, Borg score, and hemodynamics without a ceiling effect (all p < 0.001). Walking distance at baseline and after treatment predicted survival; the area under the receiver operating characteristic curve for ability of ISWT distance to predict mortality was 0.655 (95% confidence interval 0.553-0.757; p = 0.004) at baseline and 0.737 (95% confidence interval 0.643-0.827; p < 0.001) at 1 year after initiation of treatment. Change in ISWT distance also predicted survival (p = 0.04). Heart rate (HR) and systolic blood pressure (SBP) parameters reflecting autonomic response to exercise (highest HR, change in HR, HR recovery at 1 minute >18 beats/min, highest SBP, change in SBP, and 3-minute SBP ratio) were significant predictors of survival (all p < 0.05). CONCLUSIONS: In patients with PAH, the ISWT is simple to perform, allows assessment of maximal exercise capacity, is sensitive to treatment effect, predicts outcome, and has no ceiling effect. Also, measures of autonomic function made post-exercise predict survival in PAH.
Authors: Marcelle Paula-Ribeiro; Indyanara C Ribeiro; Liliane C Aranda; Talita M Silva; Camila M Costa; Roberta P Ramos; Jaquelina S Ota-Arakaki; Sergio L Cravo; Luiz E Nery; Michael K Stickland; Bruno M Silva Journal: J Physiol Date: 2019-01-30 Impact factor: 5.182
Authors: Catherine G Billings; Robert Lewis; Iain J Armstrong; Judith A Hurdman; Ian A Smith; Matthew Austin; Charlie A Elliot; Athanasios Charalampopoulos; Ian Sabroe; Allan Lawrie; A A Roger Thompson; Robin Condliffe; David G Kiely Journal: Front Med (Lausanne) Date: 2018-06-21
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Authors: Robert A Lewis; Christopher S Johns; Marcella Cogliano; David Capener; Euan Tubman; Charlie A Elliot; Athanasios Charalampopoulos; Ian Sabroe; A A Roger Thompson; Catherine G Billings; Neil Hamilton; Kathleen Baster; Peter J Laud; Peter M Hickey; Jennifer Middleton; Iain J Armstrong; Judith A Hurdman; Allan Lawrie; Alexander M K Rothman; Jim M Wild; Robin Condliffe; Andrew J Swift; David G Kiely Journal: Am J Respir Crit Care Med Date: 2020-02-15 Impact factor: 21.405
Authors: Robert A Lewis; Catherine G Billings; Judith A Hurdman; Ian A Smith; Matthew Austin; Iain J Armstrong; Jennifer Middleton; Alexander M K Rothman; John Harrington; Neil Hamilton; Abdul G Hameed; A A Roger Thompson; Athanasios Charalampopoulos; Charlie A Elliot; Allan Lawrie; Ian Sabroe; Jim M Wild; Andrew J Swift; Robin Condliffe; David G Kiely Journal: Ann Am Thorac Soc Date: 2021-01