Exercise testing determines survival in patients with diffuse parenchymal lung disease evaluated for lung transplantation

Kawut, Steven M.; O’Shea, Mitchell K.; Bartels, Matthew N.; Wilt, Jessie S.; Sonett, Joshua R.; Arcasoy, Selim M.

doi:10.1016/j.rmed.2005.03.007

Cited by 87 publications

(85 citation statements)

References 29 publications

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“…This finding differs from previous studies (6,23) and likely reflects differences in walk protocols. In the current study, patients were tested without supplemental oxygen, and the walk was halted if Sa O 2 decreased to 86%.…”

Section: Discussioncontrasting

confidence: 99%

“…Our data highlight that even mild desaturation is a risk factor for subsequent mortality. Previous studies demonstrate that desaturation during a 6MWT is associated with increased risk of subsequent mortality when evaluated as a continuous variable (6,23) or using a threshold of р 88% (4, 7). Furthermore, the latter threshold was noted to be a reproducible parameter during short-term testing (7).…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, patients were tested without supplemental oxygen, and the walk was halted if Sa O 2 decreased to 86%. Previous studies allowed the use of supplemental oxygen and also tolerated greater degrees of desaturation (6,23). In the current study, 87 (44%) of the patients failed to complete the 6MWT; 84 (97%) of these patients were stopped due to an Sa O 2 of less than 86%.…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic Pulmonary Fibrosis

Flaherty

Andrei

Murray

et al. 2006

Am J Respir Crit Care Med

325

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Rationale and Hypothesis: Idiopathic pulmonary fibrosis is a fatal disease with a variable rate of progression. We hypothesized that changes in distance walked and quantity of desaturation during a six-minute-walk test (6MWT) would add prognostic information to changes in FVC or diffusing capacity for carbon monoxide. Methods: One hundred ninety-seven patients with idiopathic pulmonary fibrosis were evaluated. Desaturation during the 6MWT was associated with increased mortality even if a threshold of 88% was not reached. Baseline walk distance predicted subsequent walk distance but was not a reliable predictor of subsequent mortality in multivariate survival models. The predictive ability of serial changes in physiology varied when patients were stratified by the presence/absence of desaturation р 88% during a baseline 6MWT. For patients with a baseline saturation р 88% during a 6MWT, the strongest observed predictor of mortality was serial change in diffusing capacity for carbon monoxide. For patients with saturation Ͼ 88% during their baseline walk test, serial decreases in FVC and increases in desaturation area significantly predicted subsequent mortality, whereas decreases in walk distance and in diffusing capacity for carbon monoxide displayed less consistent statistical evidence of increasing mortality in our patients. Conclusion: These data highlight the importance of stratifying patients by degree of desaturation during a 6MWT before attributing prognostic value to serial changes in other physiologic variables.Keywords: idiopathic pulmonary fibrosis; six-minute-walk test; prognosis; pulmonary function; survival Idiopathic pulmonary fibrosis (IPF) is a uniformly fatal disease with a variable rate of progression. Identification of readily available baseline and short-term serial predictors of survival is critical for physicians and patients considering options such as lung transplantation and for the investigation of novel treatments. Recent studies have suggested several demographic (age, smoking), physiologic (diffusion capacity for carbon monoxide [Dl CO ], FVC, and desaturation), radiologic (high-resolution computed tomography [HRCT] fibrosis score), and histopathologic (fibroblastic foci) features are associated with survival (1-7). Serial change in FVC adds additional prognostic information to data obtained at baseline (8-11).(Received in original form April 6, 2006; accepted in final form June 30, 2006 ) Supported by National Institutes of Health NHLBI grants P50HL-56402, NHLBI, 2 K24 HL04212, 1 K23 HL68713, and 1K23 HL077719.Correspondence and requests for reprints should be addressed to Kevin R. A central feature in the pathophysiology of IPF is impaired gas exchange, which worsens with exercise (12, 13). This exerciseinduced widening of alveolar arterial O 2 gradient and fall in Pa O 2 is believed to be secondary to multiple abnormalities, including V /Q mismatch, decreased Pv O 2 and venous admixture (12-16). The six-min-walk test (6MWT) is a safe procedure for patients with IPF. Baseline des...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Idiopathic Pulmonary Fibrosis

Flaherty

Andrei

Murray

et al. 2006

Am J Respir Crit Care Med

325

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“…Unlike many other studies [1,33,34], this retrospective analysis focused on IPF patients affected by milder disease (mean FVC 70.2%, and mean DLCO 47.9%) [32]. The study demonstrated the importance of the initial evaluation of PH and supported previous observations indicating that PH is not just a result of restrictive impairment in patients with IPF [1,20,35]. In the study by KIMURA et al [32], higher mean PAP was an independent prognostic factor, comparable to FVC % predicted, a well-known prognostic indicator in IPF.…”

Section: Prognostic Significance Of Ph In Ipfsupporting

confidence: 70%

Pulmonary hypertension in chronic interstitial lung diseases

Caminati¹,

Cassandro²,

Harari³

2013

Eur Respir Rev

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Pulmonary hypertension (PH) is a common complication of interstitial lung diseases (ILDs), particularly in idiopathic pulmonary fibrosis and ILD associated with connective tissue disease. However, other lung diseases, such as combined pulmonary fibrosis and emphysema syndrome, pulmonary Langerhans cell histiocytosis, and lymphangioleiomyomatosis, may also include PH in their clinical manifestations. In all of these diseases, PH is associated with reduced exercise capacity and poor prognosis. The degree of PH in ILDs is typically mild-to-moderate. However, some of these patients may develop a disproportionate increase in PH that cannot be justified solely by hypoxia and parenchymal injury: this condition has been termed “out-of-proportion” PH. The pathogenesis of PH in these diseases is various, incompletely understood and may be multifactorial. The clinical suspicion (i.e. increased dyspnoea, low diffusion capacity) and echocardiographic assessment are the first steps towards proper diagnosis of PH; however, right heart catheterisation remains the current gold standard for diagnosis of PH. At present, no specific therapies have been approved for the treatment of PH in patients with ILDs

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“…It is believed that a reduction of DL,CO level below 50% of the predicted value is an important indication for the initiation of therapeutic intervention. Cardiopulmonary exercise testing and 6-min walk distance are also important for the evaluation of the functional status of SSc patients [24], they can identify factors limiting exercise [70,71], evaluate the effect of pharmacological or nonpharmacological interventions [72] and predict survival [73]. However, they do not lack cardinal limitations.…”

Section: Clinical and Laboratory Featuresmentioning

confidence: 99%

Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement: Table 1—

Antoniou¹,

Margaritopoulos²,

Economidou³

et al. 2009

Eur Respir J

151

122

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The connective tissue disorders (CTDs), also called collagen vascular diseases (CVDs), represent a heterogeneous group of immunologically mediated inflammatory disorders with a large variety of affected organs. Individuals with a CTD (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, polymyositis/dermatomyositis and mixed connective tissue disease) are susceptible to respiratory involvement. When the lungs are affected, an increasing mortality and morbidity in CVDs occurs. Interstitial lung disease (ILD) is established as a clinical corollary across the spectrum of CTDs, with an overall incidence estimated at 15%.Therefore, pivotal clinical dilemmas remain in the evaluation and management of ILD involvement in CVDs. Critical questions are the presence of fibrosis and whether the disease is clinically significant. Moreover, the clinician has to decide if treatment is warranted and which is the best therapeutic approach. The use of additional tests, such as pulmonary function tests, high-resolution computed tomography scan, bronchoalveolar lavage fluid and surgical lung biopsy, deserves better discussion. The present review focuses on establishing the diagnosis of ILD in CTD, and on evaluating disease activity and prognosis. This will provide the basis for therapeutic decisions that will be discussed, including an overview of recent advances.

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Exercise testing determines survival in patients with diffuse parenchymal lung disease evaluated for lung transplantation

Abstract: Cardiopulmonary exercise test parameters and the 6MWTD were associated with the risk of death. Measures during exercise may be useful for determination of prognosis and for prioritizing patients with diffuse parenchymal lung disease for lung transplantation.

Cited by 87 publications

References 29 publications

Idiopathic Pulmonary Fibrosis

Idiopathic Pulmonary Fibrosis

Pulmonary hypertension in chronic interstitial lung diseases

Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement: Table 1—

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