结节病相关性肺动脉高压的六分钟步行试验：一项国际注册研究的结果

The six-minute walk test in sarcoidosis associated pulmonary hypertension: Results from an international registry.

作者信息

Gupta Rohit, Baughman Robert P, Nathan Steven D, Wells Athol U, Kouranos Vasilis, Alhamad Esam H, Culver Daniel A, Barney Joseph, Carmona Eva M, Cordova Francis C, Huitema Marloes, Scholand Mary Beth, Wijsenbeek Marlies, Ganesh Sivagini, Birring Surinder S, Price Laura C, Wort Stephen John, Shlobin Oksana A

机构信息

Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.

出版信息

Respir Med. 2022 May;196:106801. doi: 10.1016/j.rmed.2022.106801. Epub 2022 Mar 16.

DOI:10.1016/j.rmed.2022.106801

PMID:35316723

Abstract

INTRODUCTION

Sarcoidosis associated pulmonary hypertension (SAPH) is a leading contributor to sarcoidosis-related mortality. The 6-min walk test (6MWT) is widely used in assessment of cardiorespiratory conditions. A reduced 6-min walk distance (6MWD) has been associated with increased mortality in SAPH. We examined patients from the Registry of Sarcoidosis Associated Pulmonary Hypertension (ReSAPH) who had performed 6MWT at enrollment to identify variables that affect 6MWD, and the prognostic value of 6MWT variables regarding death or lung transplantation.

MATERIAL AND METHODS

ReSAPH patients with available 6MWT were included. Variables analyzed using pre-defined cutoffs included 6MWD, initial and end of test Borg dyspnea score, oxygen saturation, and heart rate at beginning, end, and after 1-min recovery, absolute change in oxygen saturation, modified distance-saturation product (mDSP), and the heart rate recovery at 1-min (HRR).

FINDINGS

174 patients met inclusion criteria; 48 patients died and 8 underwent lung transplantation. Patients with 6MWD<300 m had a higher chance of dying or undergoing transplantation compared to those with 6MWD>300 m (p = 0.012). No associations with outcome were observed with mDSP cutoff 200 m%, desaturation≥5% and oxygen saturation<88% at end of 6MWT, or multiple HRR cutoffs (13,14,16). 6MWD correlated with initial Borg score, (p = 0.001), DLCO% (p = 0.0001) and sPAP (p = 0.031) on multivariate analysis. These variables were significant for both pre- and post-capillary PH subgroups. 6MWD also correlated with fatigue assessment scale (FAS) (p = 0.015).

CONCLUSION

Of the parameters evaluated, 6MWD had the greatest prognostic value in SAPH which correlated with other physiologic and hemodynamic variables. 6MWT captures the multidimensional effects of sarcoidosis.

摘要

引言

结节病相关肺动脉高压（SAPH）是结节病相关死亡的主要原因。6分钟步行试验（6MWT）广泛用于评估心肺状况。6分钟步行距离（6MWD）缩短与SAPH患者死亡率增加相关。我们研究了结节病相关肺动脉高压登记处（ReSAPH）中在入组时进行了6MWT的患者，以确定影响6MWD的变量，以及6MWT变量对死亡或肺移植的预后价值。

材料与方法

纳入有可用6MWT数据的ReSAPH患者。使用预定义临界值分析的变量包括6MWD、试验开始和结束时的Borg呼吸困难评分、氧饱和度、试验开始、结束和1分钟恢复后的心率、氧饱和度的绝对变化、改良距离-饱和度乘积（mDSP）以及1分钟时的心率恢复（HRR）。

研究结果

174例患者符合纳入标准；48例患者死亡，8例接受了肺移植。与6MWD>300 m的患者相比，6MWD<300 m的患者死亡或接受移植的可能性更高（p = 0.012）。在6MWT结束时，mDSP临界值200 m%、氧饱和度下降≥5%和氧饱和度<88%，或多个HRR临界值（13、14、16）与预后均无关联。多因素分析显示，6MWD与初始Borg评分（p = 0.001）、DLCO%（p = 0.0001）和sPAP（p = 0.031）相关。这些变量在毛细血管前和毛细血管后PH亚组中均具有显著性。6MWD还与疲劳评估量表（FAS）相关（p = 0.015）。