Wensel, Roland and Francis, Darrel P. and Meyer, F. Joachim and Opitz, Christian F. and Bruch, Leonhard and Halank, Michael and Winkler, Joerg and Seyfarth, Hans-Juergen and Glaeser, Sven and Blumberg, Friedrich and Obst, Anne and Dandel, Michael and Hetzer, Roland and Ewert, Ralf (2013) Incremental prognostic value of cardiopulmonary exercise testing and resting haemodynamics in pulmonary arterial hypertension. INTERNATIONAL JOURNAL OF CARDIOLOGY, 167 (4). pp. 1193-1198. ISSN 0167-5273, 1874-1754
Full text not available from this repository. (Request a copy)Abstract
Background: Pulmonary arterial hypertension (PAH) is a fatal disease despite recent treatment advances. Individual risk stratification is important. Exercise capacity and invasive haemodynamic data are both relevant, but data on the combined prognostic power are lacking. Methods: 226 consecutive patients with idiopathic or familial PAH were included at seven specialised tertiary centres. All patients underwent right heart catheterization and cardiopulmonary exercise testing (CPET). Results: During follow-up (1508+/-1070 days) 72 patients died and 30 underwent transplantation. On multivariate analysis percentage of predicted peak oxygen uptake (%predicted peak VO2 [risk ratio 0.95]), pulmonary vascular resistance (PVR [1.105,]) and increase in heart rate during exercise (Delta HR [0.974]) were independent prognostic predictors (all p<0.0001). Peak VO2 allowed for risk stratification with a survival of 100, 92.9, 87.4 and 69.6% at 1 year and 97.7, 63.2, 41 and 23% at 5 years for the 4th, 3rd, 2nd and 1st quartiles, respectively. Dichotomizing by median peak VO2 and intra-group median PVR showed a worse 1-year survival for patients with low peak VO2/higher PVR compared to patients with low peak VO2/low PVR, high peak VO2/high PVR and high peak VO2/low PVR (65 vs. 93, 93, 100%, p<0.001). At 10 years survival was different for all 4 subgroups (19 vs. 25 vs. 48 vs. 75%, adjusted p<0.05). Conclusions: Peak VO2, PVR and Delta HR independently predict prognosis in patients with PAH. Low peak VO2, high PVR and low Delta HR refer to poor prognosis. Combined use of peak VO2 and PVR provides accurate risk stratification underlining the complementary prognostic information from cardiopulmonary exercise testing and resting invasive haemodynamic data. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RISK STRATIFICATION; OXYGEN-CONSUMPTION; MUSCLE DYSFUNCTION; HEART-FAILURE; SURVIVAL; DISEASE; DIAGNOSIS; BOSENTAN; EQUATION; Pulmonary arterial hypertension; Prognosis; Cardiopulmonary exercise testing; Haemodynamics |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 02 Apr 2020 09:45 |
| Last Modified: | 02 Apr 2020 09:45 |
| URI: | https://pred.uni-regensburg.de/id/eprint/16222 |
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