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Open AccessArticle

Prognostication in Pulmonary Arterial Hypertension with Submaximal Exercise Testing

1
Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
2
Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Maurizio Battino
Diseases 2015, 3(1), 15-23; https://doi.org/10.3390/diseases3010015
Received: 11 December 2014 / Revised: 26 December 2014 / Accepted: 27 January 2015 / Published: 6 February 2015
Introduction: The submaximal exercise test (SET), which gives both a measure of exercise tolerance, as well as disease severity, should be a more robust functional and prognostic marker than the six-minute walk test (6MWT). This study aimed to determine the prognostic value of SET as predicted by the validated REVEAL (Registry to Evaluate Early and Long-Term Pulmonary Artery Hypertension Disease Management) registry risk score (RRRS). Methods: Sixty-five consecutive patients with idiopathic and associated pulmonary arterial hypertension (PAH) underwent right-heart catheterization, echocardiogram, 6MWT and a three-minute SET (Shape-HF™). Analyses explored the association between SET variables and prognosis predicted by the RRRS. Results: Although multiple SET variables correlated with the RRRS on univariate analyses, only VE/VCO2 (r = 0.57, p < 0.0001) remained an independent predictor in multivariate analysis (β = 0.05, p = 0.0371). Additionally, the VE/VCO2 was the most discriminatory (area under receiver operating characteristic curve, 0.84) in identifying the highest-risk category (RRRS ≥ 10), with an optimal cut-off of 40.6, resulting in a high sensitivity (92%) and negative-predictive value (97%), but a lower specificity (67%). Conclusion: SETs, particularly the VE/VCO2, appear to have prognostic value when compared to the RRRS. If validated in prospective trials, SET should prove superior to the 6MWT or the RRRS, with significant implications for both future clinical trials and clinical practice. View Full-Text
Keywords: submaximal exercise test; pulmonary artery hypertension; REVEAL registry; cardiopulmonary exercise test; VE/VCO2 submaximal exercise test; pulmonary artery hypertension; REVEAL registry; cardiopulmonary exercise test; VE/VCO2
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Khatri, V.; Neal, J.E.; Burger, C.D.; Lee, A.S. Prognostication in Pulmonary Arterial Hypertension with Submaximal Exercise Testing. Diseases 2015, 3, 15-23.

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