Cardiac Effort to Compare Clinic and Remote 6-Minute Walk Testing in Pulmonary Arterial Hypertension

Lachant, D.; Kennedy, Ethan; Derenze, Blaise; Light, Albert; Lachant, M.; White, R. James

doi:10.1016/j.chest.2022.06.025

Cited by 10 publications

(15 citation statements)

References 30 publications

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“…2). 15,16 Cardiac Effort performed well in the home setting 17 and both Cardiac Effort and 6MWD have correlated strongly with SV assessed by MUGA 15 and right heart catheterization. 16 To our surprise, the present analyses do not argue that Cardiac Effort adds much to 6MWD in terms of indicating impaired SV or RVEF, perhaps because the participants gave a near maximal effort.…”

Section: Discussionmentioning

confidence: 78%

“…Importantly, electrocardiogram heart rate recording has significantly better data quality and acquisition compared to photoplethysmography (wrist or finger-based devices). 15,17 In our first attempts to measure Cardiac Effort, we had >25% data loss with photoplethysmography 15 ; we did not lose any data here, and at this time, electrocardiogram heart rate monitoring is necessary for accurate Cardiac Effort. It is also critical to interrogate signal quality (visualize raw electrocardiogram data), as artifact can be misinterpreted by algorithms and report incorrect heart rates.…”

Section: Discussionmentioning

confidence: 98%

“…Cardiac Effort potentially helps fill this gap and can put frequent, serial testing in easy reach of all clinicians, including within the home setting. 17 …”

Section: Discussionmentioning

confidence: 99%

“… 19 MC10 Biostamp nPoint provided continuous electrocardiogram monitoring to calculate Cardiac Effort as previously described, (heart beats during 6MWT)/6MWD). 16 , 17 cMRI was completed on Siemens Aera 1.5 T scanner within 24 h of 6MWT. A chest radiologist not affiliated with the study team (therefore blinded to walk distance) with expertise in cMRI reported right and left ventricle volumes.…”

Section: Methodsmentioning

confidence: 99%

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Cardiac effort and 6‐min walk distance correlate with stroke volume measured by cardiac magnetic resonance imaging

Lachant,

Haight

et al. 2024

Pulm. circ.

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Right ventricular (RV) dysfunction in pulmonary arterial hypertension (PAH) is associated with poor outcomes. Cardiac magnetic resonance imaging (cMRI) is the gold standard for volumetric assessment, and few reports have correlated 6‐min walk distance (6MWD) and cMRI parameters in PAH. Cardiac Effort, (the number of heart beats used during 6‐min walk test)/(6MWD), incorporates physiologic changes into walk distance and has been associated with stroke volume (SV) measured by nuclear imaging and indirect Fick. Here, we aimed to interrogate the relationship of Cardiac Effort and 6MWD with SV measured by the gold standard, cMRI. This was a single‐center, observational, prospective study in Group 1 PAH patients. Subjects completed 6‐min walk with heart rate monitoring (Cardiac Effort) and cMRI within 24 h. cMRI was correlated to Cardiac Effort and 6MWD using Spearman Correlation Coefficient. Twenty‐five participants with a wide range of RV function completed both cMRI and Cardiac Effort. There was a strong correlation between left ventricle SV index and both Cardiac Effort (r = −0.70, p = 0.0001) and 6MWD (r = 0.67, p = 0.0002). Cardiac Effort and 6MWD were statistically separated in patients at prognostically significant thresholds of left ventricle SV index (>31 ml/m2), RV Ejection Fraction (>35%), and SV/End Systolic Volume ( > 0.53). Cardiac Effort and 6MWD are noninvasive ways to gain insight into those with impaired SV. 6MWD may correlate better with SV than previously thought and heart rate monitoring provides physiologic context to the walk distance obtained.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 98%

“…Cardiac Effort potentially helps fill this gap and can put frequent, serial testing in easy reach of all clinicians, including within the home setting. 17 …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac effort and 6‐min walk distance correlate with stroke volume measured by cardiac magnetic resonance imaging

Lachant,

Haight

et al. 2024

Pulm. circ.

Self Cite

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show abstract

“…Baseline testing included 6MWD 18 without a mask, cardiac effort, 19 , 20 , 21 emPHasis‐10 questionnaire, 22 N ‐terminal pro b‐type natriuretic peptide (NT‐pro‐BNP), CBC, functional class assessment, and REVEAL 2.0 Lite score. 23 After baseline testing, subjects wore ActiGraph GT9X Link (nondominant wrist) and MC10 Biostamp nPoint (affixed to chest and thigh with a disposable adhesive, see Supporting Information: Figure 1 ) for 7 days.…”

Section: Methodsmentioning

confidence: 99%

Peak steps: Capacity for activity improves after adding approved therapy in pulmonary arterial hypertension

Lachant,

Light,

Lachant

et al. 2023

Pulm. circ.

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Pulmonary arterial hypertension (PAH) patients have low activity. Activity intensity or duration could be a measure of clinical status or improvement. We aimed to determine whether standard or novel actigraphy measures could detect increases in activity after adding therapy. This was a prospective, single‐center observational study evaluating activity after adding therapy in Group 1 PAH; we also report a validation cohort. For our study, two different accelerometers were used, a wrist (ActiGraph) and chest (MC10) device. Patients were analyzed in two groups, Treatment Intensification (TI, adding therapy) or Stable. Both groups had baseline monitoring periods of 7 days; the TI group had follow‐up at 3 months, while Stables had follow‐up within 4 weeks to assess stability. Activity time and steps were reported from both devices' proprietary algorithms. In ActiGraph only, steps in 1‐min intervals throughout the day were ranked (not necessarily contiguous). Average values for each week were calculated and compared using nonparametric testing. Thirty patients had paired data (11 Stable and 19 TI). There was no between‐group difference at baseline; we did not observe therapy‐associated changes on average daily steps or activity time/intensity. The top 5 min of steps (capacity) increased after adding therapy; there was no difference in the stable group. This key finding was validated in a previously reported randomized trial studying a behavioral intervention to increase exercise. Total daily activity metrics are influenced by both disease and non‐disease factors, making therapy‐associated change difficult to detect. Peak minute steps were a treatment‐responsive marker in both a pharmacologic and training intervention.

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A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation

Child,

Kelly,

Sizelove

et al. 2023

Respiratory Medicine

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Cardiac Effort to Compare Clinic and Remote 6-Minute Walk Testing in Pulmonary Arterial Hypertension

Cited by 10 publications

References 30 publications

Cardiac effort and 6‐min walk distance correlate with stroke volume measured by cardiac magnetic resonance imaging

Cardiac effort and 6‐min walk distance correlate with stroke volume measured by cardiac magnetic resonance imaging

Peak steps: Capacity for activity improves after adding approved therapy in pulmonary arterial hypertension

A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation

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