Reproducibility of Cardiopulmonary Exercise Measurements in Patients With Pulmonary Arterial Hypertension

Hansen, James E.; Sun, Xiaocun; Yasunobu, Yuji; Garafano, Robert P.; Gates, Gregory J.; Barst, Robyn J.; Wasserman, Karlman

doi:10.1378/chest.126.3.816

Cited by 93 publications

(72 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Test performance in RCT participants with PAH appears reliable [97]. VO 2 max and the ventilatory equivalent for carbon dioxide with exercise are abnormal in patients with PAH, and these and other parameters are associated with hemodynamics [20,45,[97][98][99][100][101][102][103].…”

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 97%

Surrogate End Points in Pulmonary Arterial Hypertension: Assessing the Response to Therapy

Snow¹,

Kawut²

2007

Clinics in Chest Medicine

View full text Add to dashboard Cite

Pulmonary arterial hypertension (PAH) is a rare disease which is characterized by increased pulmonary vascular resistance and right heart failure. Recent discoveries in disease pathophysiology have been translated into effective therapies tested in clinical trials. The studies which have led to the regulatory board approval of therapies for PAH have focused on surrogate and intermediate end points, thought to reflect quantity and quality of life, respectively. However, validation of many of these surrogates is incomplete. It is also unknown which indicators of function or long-term survival should be used to formulate decisions regarding addition, discontinuation, or combination of therapies. Identification of suitable end points would therefore not only help investigators design appropriate clinical trials, but also assist clinicians in caring for patients with PAH. Hemodynamic, cardiac imaging, plasma biomarkers, and exercise testing hold some promise as potential surrogate end points for PAH. Functional status and quality of life assessments may also have important roles. Future studies should validate the most promising surrogate markers, so that patients, clinicians, subjects, and investigators may benefit from the advantages they confer on clinical care and on clinical trials.The past several years have yielded an explosion of randomized clinical trials (RCTs) of several new medical therapies for pulmonary arterial hypertension (PAH). The hopes for these and all treatments for potentially fatal diseases are 1) to improve how a patient feels or functions and/ or 2) to prolong survival. While simply stated, the assessment of progress towards these goals may be quite complex [1][2][3][4][5][6].New PAH therapies have gained regulatory board approval based on studies with intermediate and surrogate end points as primary outcomes, believed to reflect the impact of these drugs on quality of life (QOL) and survival, respectively. While hemodynamic, plasma, cardiac imaging, exercise, functional, and QOL parameters are promising candidates, the reliability and validity of these measures are not clearly established. In addition, there are no RCTs addressing the use of such end points in guiding management decisions in PAH, such as changing, intensifying, escalating, or combining therapies. Despite this lack of evidence, clinicians who

show abstract

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 97%

Surrogate End Points in Pulmonary Arterial Hypertension: Assessing the Response to Therapy

Snow¹,

Kawut²

2007

Clinics in Chest Medicine

View full text Add to dashboard Cite

show abstract

“…Recent research in patients with PPH has confirmed that reductions in V9O 2 ,peak not only reflect a reduced ability to deliver and utilise oxygen at the tissue level [22] but also that it is a reproducible measurement [130].…”

Section: Oxygen Transport Abnormalitiesmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

560

390

View full text Add to dashboard Cite

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?''

show abstract

“…It has been postulated that this lead to inaccurate results at the less experienced sites and failure of the outcome measure to show a signal. As support for this a single centre study in PAH subjects [96] -a healthy response would parallel this line. Note the shallower VO 2 /WR slope and reduced peak VO 2 in PAH.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 56%

“…In the largest study looking at CPET in high risk cardiovascular patients (n = 5060 CPET events) [97], adverse event rate was 0.16% with no fatalities. In a study dedicated to PAH [96], there were no events in 242 tests. In summary, studies of CPET in PAH have been encouraging but not unconditionally so.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

“…The safety of maximal incremental CPET in PAH subjects has been questioned. Multiple studies in adults [83,96,97] and children [89,98,99] have suggested that this is not a problem. In the largest study looking at CPET in high risk cardiovascular patients (n = 5060 CPET events) [97], adverse event rate was 0.16% with no fatalities.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

See 1 more Smart Citation

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

Johnson

Thomson

2014

Diseases

View full text Add to dashboard Cite

A culture of exercise testing is firmly embedded in the management of pulmonary arterial hypertension (PAH) but its clinical relevance and utility have recently been under some debate. The six minute walk test (6MWT) has been used as a primary outcome measure to enable the licensing of many of the medications used for this condition. Recent reviews have questioned the validity of this test as a surrogate of clinical outcomes. At the same time, other questions are emerging where exercise testing may be the solution. With the rise in understanding of genetic markers of idiopathic PAH (IPAH), the screening of an otherwise healthy population for incipient pulmonary hypertension (PH) will be required. The proliferation in treatment choices and identification of populations with PH where PAH treatment is not indicated, such as left heart and lung disease, requires more definitive differentiation from patients with PAH. There is a continuing question about the existence and clinical relevance of exercise induced PAH as a cause of unexplained dyspnoea and fatigue and as a latent phase of resting PH. This review presents a summary and critical analysis of the current role of exercise testing in PAH and speculates on future trends.

show abstract

Reproducibility of Cardiopulmonary Exercise Measurements in Patients With Pulmonary Arterial Hypertension

Cited by 93 publications

References 28 publications

Surrogate End Points in Pulmonary Arterial Hypertension: Assessing the Response to Therapy

Surrogate End Points in Pulmonary Arterial Hypertension: Assessing the Response to Therapy

Recommendations on the use of exercise testing in clinical practice

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

Contact Info

Product

Resources

About