Incremental shuttle walk test distance and autonomic dysfunction predict survival in pulmonary arterial hypertension

Billings, Catherine; Hurdman, Judith; Condliffe, Robin; Elliot, Charlie; Smith, Ian; Austin, Matthew; Armstrong, Iain; Hamilton, Neil; Charalampopoulos, Athanasios; Sabroe, Ian; Swift, Andrew J.; Rothman, Alexander; Wild, Jim M.; Lawrie, Allan; Waterhouse, J C; Kiely, David G.

doi:10.1016/j.healun.2017.04.008

Cited by 19 publications

(25 citation statements)

References 39 publications

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“…; Billings et al . ). It is possible that the carotid chemoreceptors also play a role in the post‐exercise cardiac autonomic control in patients with more advanced disease and hypoxaemia during exercise, but it is uncertain whether the magnitude of such a phenomenon would be similar to the data reported in the present study.…”

Section: Discussionmentioning

confidence: 97%

Carotid chemoreflex activity restrains post‐exercise cardiac autonomic control in healthy humans and in patients with pulmonary arterial hypertension

Paula‐Ribeiro

Ribeiro

Aranda

et al. 2019

The Journal of Physiology

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Key pointsr Dysfunction of post-exercise cardiac autonomic control is associated with increased mortality risk in healthy adults and in patients with cardiorespiratory diseases.r The afferent mechanisms that regulate the post-exercise cardiac autonomic control remain unclear.r We found that afferent signals from carotid chemoreceptors restrain the post-exercise cardiac autonomic control in healthy adults and patients with pulmonary arterial hypertension (PAH).r Patients with PAH had higher carotid chemoreflex sensitivity, and the magnitude of carotid chemoreceptor restraint of autonomic control was greater in patients with PAH as compared to healthy adults.r The results demonstrate that the carotid chemoreceptors contribute to the regulation of post-exercise cardiac autonomic control, and suggest that the carotid chemoreceptors may be a potential target to treat post-exercise cardiac autonomic dysfunction in patients with PAH.Abstract Dysfunction of post-exercise cardiac autonomic control predicts mortality, but its underlying mechanisms remain unclear. We tested whether carotid chemoreflex activity restrains post-exercise cardiac autonomic control in healthy adults (HA), and whether such restraint is greater in patients with pulmonary arterial hypertension (PAH) who may have both altered carotid chemoreflex and altered post-exercise cardiac autonomic control. Twenty non-hypoxaemic patients with PAH and 13 age-and sex-matched HA pedalled until 90% of peak work rate observed in a symptom-limited ramp-incremental exercise test. Recovery consisted of unloaded pedalling for 5 min followed by seated rest for 6 min. During recovery, subjects randomly inhaled either 100% O 2 (hyperoxia) to inhibit the carotid chemoreceptor activity, or 21% O 2 (normoxia) as control. Post-exercise cardiac autonomic control was examined via heart rate (HR) recovery (HRR; HR change after 30, 60, 120 and 300 s of recovery, using linear and non-linear regressions of HR decay) and HR variability (HRV; time and spectral domain analyses). As expected, the PAH group had higher carotid chemosensitivity and worse post-exercise HRR and HRV than HA. Hyperoxia increased HRR at 30, 60 and 120 s and absolute spectral power HRV in both groups.Additionally, hyperoxia resulted in an accelerated linear HR decay and increased time domain HRV during active recovery only in the PAH group. In conclusion, the carotid chemoreceptors restrained recovery of cardiac autonomic control from exercise in HA and in patients with PAH, with the restraint greater for some autonomic indexes in patients with PAH.

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Section: Discussionmentioning

confidence: 97%

Carotid chemoreflex activity restrains post‐exercise cardiac autonomic control in healthy humans and in patients with pulmonary arterial hypertension

Paula‐Ribeiro

Ribeiro

Aranda

et al. 2019

The Journal of Physiology

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“…Of note, this finding was valid only in patients with severe PH. In addition, a study from Sheffield (UK) analysing the shuttle walk test found that an inadequate heart rate response was associated with mortality [73]. They concluded that the shuttle walk test was easy to perform and sensitive to the effects of therapy.…”

Section: Outcome Measuresmentioning

confidence: 99%

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

et al. 2018

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Objectives of this European Respiratory Society task force were to summarise current studies, to develop strategies for future research and to increase availability and awareness of exercise training for pulmonary hypertension (PH) patients.An evidence-based approach with clinical expertise of the task force members, based on both literature search and face-to-face meetings was conducted. The statement summarises current knowledge and open questions regarding clinical effects of exercise training in PH, training modalities, implementation strategies and pathophysiological mechanisms.In studies (784 PH patients in total, including six randomised controlled trials, three controlled trials, 10 prospective cohort studies and four meta-analyses), exercise training has been shown to improve exercise capacity, muscular function, quality of life and possibly right ventricular function and pulmonary haemodynamics. Nevertheless, further studies are needed to confirm these data, to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.As exercise training appears to be effective, cost-efficient and safe, but is scarcely reimbursed, support from healthcare institutions, commissioners of healthcare and research funding institutions is greatly needed. There is a strong need to establish specialised rehabilitation programmes for PH patients to enhance patient access to this treatment intervention.

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“…The ISWT will be performed as per European Respiratory Society (ERS)/American Thoracic Society (ATS) guidelines [17]. The externally paced ISWT is a simple assessment of maximal exercise capacity and, in PH, is sensitive to treatment effect, predicts mortality, and has no ceiling effect [31].…”

Section: Primary Outcomementioning

confidence: 99%

Supervised pulmonary hypertension exercise rehabilitation (SPHERe): study protocol for a multi-centre randomised controlled trial

et al. 2020

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Background: Supervised cardio-pulmonary rehabilitation may be safe and beneficial for people with pulmonary hypertension (PH) in groups 1 (pulmonary arterial hypertension) and 4 (chronic thromboembolic disease), particularly as a hospital in-patient. It has not been tested in the most common PH groups; 2 (left heart disease), 3 (lung disease), or 5 (other disorders). Further it has not been evaluated in the UK National Health Service (NHS) outpatient setting, or with long-term follow-up. The aim of this randomised controlled trial (RCT) is to test the clinical and cost-effectiveness of a supervised exercise rehabilitation intervention with psychosocial support compared to best practice usual care for people with PH in the community/outpatient setting.

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Incremental shuttle walk test distance and autonomic dysfunction predict survival in pulmonary arterial hypertension

Abstract: In patients with PAH, the ISWT is simple to perform, allows assessment of maximal exercise capacity, is sensitive to treatment effect, predicts outcome, and has no ceiling effect. Also, measures of autonomic function made post-exercise predict survival in PAH.

Cited by 19 publications

References 39 publications

Carotid chemoreflex activity restrains post‐exercise cardiac autonomic control in healthy humans and in patients with pulmonary arterial hypertension

Carotid chemoreflex activity restrains post‐exercise cardiac autonomic control in healthy humans and in patients with pulmonary arterial hypertension

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

Supervised pulmonary hypertension exercise rehabilitation (SPHERe): study protocol for a multi-centre randomised controlled trial

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