Alsina-Restoy Xavier, Torres-Castro Rodrigo, Torralba-García Yolanda, Burgos Felip, Barberà Joan Albert, Agustí Àlvar, Blanco Isabel
Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
Respir Med. 2023 Jan;206:107070. doi: 10.1016/j.rmed.2022.107070. Epub 2022 Dec 5.
The 6-min walking distance (6MWD) is often used to assess prognosis in pulmonary arterial hypertension (PAH) patients. Whether or not changes in arterial oxygen saturation (SpO) during exercise add prognostic value to the 6MWD in these patients is unclear. The objective of this study was to investigate if SpO changes during exercise adds prognostic value to the 6MWD in PAH patients.
Ambispective study that includes 137 patients with PAH: 38 idiopathic/heritable (i/h PAH), 42 with connective tissue disease (CTD-PAH), 34 with porto-pulmonary hypertension (PoPH), 21 with HIV-associated PAH and 2 with pulmonary venous occlusive disease (PVOD). Patients were characterized and, treated according to international recommendations, and were followed-up for 5 years. To integrate SpO changes during exercise, we calculated the desaturation distance ratio (DDR) either in its original form (from a maximal theoretical value of 100%) or the actual resting SpO value of the patient (new DDR) as well as the distance saturation product (DSP).
(1) during follow-up, 40 patients died (29.2%); (2) results confirmed the prognostic value of the 6MWD (AUC 0.913 [IQR 0.868-0.958]; p < 0.0001), original DDR (AUC 0.923 [0.881-0.966]; p < 0.001), New DDR (AUC 0.917 [0.872-0.961], p < 0.001), and DSP (AUC 0.914 [0.869-0.959], p < 0.001); and, (3) neither the original or new DDR or DSP added significant prognostic value to 6MWD in these patients.
Consideration of three different composite indices of arterial oxygenation changes during exercise does not add prognostic value to that of the 6MWD in patients with PAH.
6分钟步行距离（6MWD）常用于评估肺动脉高压（PAH）患者的预后。运动期间动脉血氧饱和度（SpO）的变化是否能为这些患者的6MWD增加预后价值尚不清楚。本研究的目的是调查运动期间SpO变化是否能为PAH患者的6MWD增加预后价值。
前瞻性研究纳入137例PAH患者：38例特发性/遗传性（i/h PAH），42例结缔组织病相关（CTD-PAH），34例门脉性肺动脉高压（PoPH），21例HIV相关PAH，2例肺静脉闭塞性疾病（PVOD）。对患者进行特征分析，并根据国际指南进行治疗，随访5年。为纳入运动期间SpO的变化，我们计算了去饱和距离比（DDR），其原始形式（基于100%的最大理论值）或患者的实际静息SpO值（新DDR）以及距离饱和度乘积（DSP）。
（1）随访期间，40例患者死亡（29.2%）；（2）结果证实了6MWD（AUC 0.913[IQR 0.868 - 0.958]；p < 0.0001）、原始DDR（AUC 0.923[0.881 - 0.966]；p < 0.001）、新DDR（AUC 0.917[0.872 - 0.961]，p < 0.001）和DSP（AUC 0.914[0.869 - 0.959]，p < 0.001）的预后价值；（3）在这些患者中，原始或新的DDR或DSP均未为6MWD增加显著的预后价值。
考虑运动期间动脉氧合变化的三种不同综合指标并未为PAH患者的6MWD增加预后价值。
