Impairments and prognostic factors for survival in patients with idiopathic pulmonary fibrosis

Miki, Keisuke; Maekura, Ryoji; Hiraga, Toru; Okuda, Yoshinari; Okamoto, Takashi; Hirotani, Atsushi; Ogura, Takeshi

doi:10.1053/rmed.2002.1469

Cited by 89 publications

(89 citation statements)

References 16 publications

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“…Receiver operating characteristic curve analysis for cut-off points with Ͼ70% sensitivity and Ͼ60% specificity to detect mortality was performed for exercise capacity (peak V O 2 , peak work-rate) and ventilatory efficiency variables (V E /V O 2 nadir, anaerobic threshold V E /V CO 2 , and tidal volume reserve) as was previously demonstrated. 14,15,19,20 Cox regression analysis using a log-rank test was conducted for survival analysis and comparison between significant cut-off points as well as between the exercise training and control groups at the 40-month time point. Hazard ratio for death or lung transplantation using a Wald test was calculated based on variables' cut-off points that were identified as significant in the receiver operating characteristic analysis.…”

Section: Discussionmentioning

confidence: 99%

“…12 V E /V O 2 nadir was defined as the lowest value of V E /V O 2 ratio during the exercise. 14,15,19,20 A novel respiratory parameter, tidal volume reserve, which assesses tidal volume response and ventilatory efficiency during exercise, was calculated from CPET; tidal volume reserve was defined as the peak tidal volume minus the resting tidal volume. CPET parameters were compared with normal values proposed by Wasserman 34 and also expressed as percentage predicted.…”

Section: Cpetmentioning

confidence: 99%

“…Based on previously established prognostic CPET data in heart and lung disease [8][9][10][11][12][13] as well as in patients with IPF, 14,15,19,20 the primary outcomes of the current study were peak V O 2 , peak work rate, V E /V O 2 nadir, anaerobic threshold V E /V CO 2 , and tidal volume reserve cut-off points using CPET in subjects with IPF. The secondary outcome was characterizing non-survivor subjects with IPF.…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

“…[8][9][10][11][12][13] A few studies have shown several CPET parameters as prognostic predictors in subjects with IPF as well. 14,15,19,20 However, these studies have significant limitations in terms of retrospective methodology, 14 low sensitivity level, 19 and challenging implementation in clinical practice, due to complicity and lack of availability. 20 Considering these gaps in the currently available data, we aimed to identify practical prognostic predictors of mortality using cardiopulmonary exercise testing in subjects with IPF.…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

et al. 2016

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BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal interstitial lung disease associated with poor prognosis and limited effective treatment options. Reliable predictors of outcome in daily clinical practice are needed to determine high-risk patients for urgent lung transplantation referral. This study aimed to identify practical prognostic predictors of mortality using cardiopulmonary exercise testing (CPET) in IPF subjects. METHODS: Thirty-four subjects with IPF (22 men and 12 women), median age 68 (range 50 -81) y were prospectively studied. At baseline, all subjects were assessed with CPET and were followed up for 40 months from baseline. Receiver operating characteristic curve analysis was conducted to determine cut-off points of CPET variables for mortality, Cox regression analysis for survival using a log-rank test, and hazard ratio for death using a Wald test. RESULTS: Peak work rate <62 watts (P ‫؍‬ .005), peak V O 2 <13.8 mL/kg/min (P ‫؍‬ .031), tidal volume reserve <0.48 L/breath (P ‫؍‬ .010), minute ventilation to carbon dioxide (V E )/V CO 2 ) ratio at the anaerobic threshold >34 (P ‫؍‬ .02), and V E )/V O 2 nadir >34 (P ‫؍‬ .002) were detected as cut-off points associated with mortality. Non-survivor subjects were characterized by higher dyspnea levels, the presence of pulmonary hypertension assessed by echocardiography, pronounced inefficient ventilatory pattern, lower exercise capacity, and more severe desaturation during physical exertion. By the end of the study, 11 subjects (7 women and 4 men) died. Overall mean survival was 60%, 33.7 months (95% CI 30.2-37.2). CONCLUSIONS: This study provides simple, practical, and novel cut-off points for CPET as predictors of prognosis to identify high-risk IPF subjects. Impairment in exercise capacity and abnormal ventilatory responses during CPET were associated with poorer survival in IPF subjects. The findings suggest considering the use of CPET for IPF risk stratification and prediction of prognosis. (ClinicalTrials.gov registration NCT01499745.) Key words: cardiopulmonary exercise testing, survival, prognostic predictors, ventilatory response, exercise intolerance. [Respir Care 2016;61(8):1100 -1109.

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Section: Discussionmentioning

confidence: 99%

Section: Cpetmentioning

confidence: 99%

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

et al. 2016

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“…V9O 2 ,peak and V9E/V9CO 2 A retrospective study of 41 patients with a clinical diagnosis of idiopathic pulmonary fibrosis reported that Pa,O 2 slope, V9O 2 ,peak, O 2 pulse at peak exercise and V9E/V9CO 2 at peak exercise are significant predictors of survival [196]. Interestingly, among the above indices, Pa,O 2 slope was correlated most closely with the survival rate.…”

Section: Interstitial Lung Diseasesmentioning

confidence: 98%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

560

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Physical training for interstitial lung disease

Holland

Hill

2007

Cochrane Database of Systematic Reviews

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Impairments and prognostic factors for survival in patients with idiopathic pulmonary fibrosis

Cited by 89 publications

References 16 publications

The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

Recommendations on the use of exercise testing in clinical practice

Physical training for interstitial lung disease

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