Treadmill testing improves survival prediction models in pulmonary arterial hypertension

Hsu, Chih Hsin; Glassner, Cherylanne; Foreman, Aimee J.; Agarwal, Richa; Benza, Raymond J.; Frantz, Robert P.; Gomberg‐Maitland, Mardi

doi:10.1016/j.ahj.2011.09.015

Cited by 11 publications

(8 citation statements)

References 22 publications

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“…9,10,15 This reflects the San Francisco referral base 16 and the high volume of liver transplants at our center. The comparable performance of the model in a population dissimilar from the derivation cohort adds to external validity.…”

Section: Discussionmentioning

confidence: 97%

Validation of the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) pulmonary hypertension prediction model in a unique population and utility in the prediction of long-term survival

Cogswell

Kobashigawa

McGlothlin

et al. 2012

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 97%

Validation of the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) pulmonary hypertension prediction model in a unique population and utility in the prediction of long-term survival

Cogswell

Kobashigawa

McGlothlin

et al. 2012

The Journal of Heart and Lung Transplantation

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“…Data from PAH registries in Europe and the United States have provided evidence for a number of prognostic factors in PAH [36][37][38][39][40][41] and led to the development of independent risk scoring systems. These risk assessment tools have proven to be effective in accurately predicting survival in multiple patient cohorts.…”

Section: Resultsmentioning

confidence: 99%

Risk Assessment in Pulmonary Arterial Hypertension Patients: The Long and Short of it

Benza

Lohmueller

Kraisangka

et al. 2018

Advances in Pulmonary Hypertension

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Pulmonary arterial hypertension (PAH) is a chronic and rapidly progressive disease that is characterized by extensive narrowing of the pulmonary vasculature, leading to increases in pulmonary vascular resistance, subsequent right ventricular dysfunction, and eventual death. There are currently multiple approved drugs—developed as single or combination therapies in the last few years—that have improved outcome and functionality in PAH. However, despite improvement in short-term survival with these new effective therapies, PAH remains an incurable disease with a median survival of 7 years (Figure 1).1 This chronic disease state may be characterized by morbid events such as hospitalizations that herald rapid disease progression and account for a significant disease burden (Figure 2).23 Physician ability to predict PAH disease progression is critical for determining optimal care of patients. Accurate risk assessment allows clinicians to determine the patient's prognosis, identify treatment goals, and monitor disease progression and the patient's response to treatment. Risk assessment for PAH patients should include a range of clinical, hemodynamic, and exercise parameters, performed in a serial fashion over the treatment course. Patient risk stratification can also help physicians better allocate treatment resources in settings where they are scarce. If widely adopted, risk prediction can enhance the consistency of treatment approaches across PAH practitioners and improve the timeliness of referral for lung transplantation. Hence, along with advancing PAH treatment options, comprehensive risk prediction is essential to make individualized treatment decisions in the current treatment era. Several tools are currently available for assessing risk in PAH (Figure 3). These include the 2015 European Society of Cardiology/European Respiratory Society pulmonary hypertension guidelines' risk variables,4 the French registry equation,5 the National Institutes of Health risk equation,6 or a risk score such as the one derived from the Registry to Evaluate Early And Long-term PAH Disease Management.1 These registries and evaluations of clinical trial sets have provided important insights into the importance of both modifiable (eg, 6-minute walk distance, functional class, brain natriuretic peptide, and nonmodifiable (eg, age, gender, PAH etiology) risk factors that predict survival. The following review explores commonly cited risk factors, both modifiable and nonmodifiable, and their implications for patient outcomes.

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“…The REVEAL risk equation for PAH contains 6MWD. A study [158] which replaced this with treadmill test performance improved the predictive value of the equation. A treadmill version of the 6MWT has been developed where the speed of the treadmill is increased every 30 s following patient instructions [157] until a maximum is reached.…”

Section: Field Exercise Testsmentioning

confidence: 99%

“…Treadmill based walks have been proposed by several authors [155][156][157][158]. This is a convenient method of administering an exercise test not requiring a corridor with well-established protocols (such as Naughton-Balke) developed primarily for cardiac stress testing.…”

Section: Field Exercise Testsmentioning

confidence: 99%

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

Johnson

Thomson

2014

Diseases

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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.

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Treadmill testing improves survival prediction models in pulmonary arterial hypertension

Cited by 11 publications

References 22 publications

Validation of the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) pulmonary hypertension prediction model in a unique population and utility in the prediction of long-term survival

Validation of the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) pulmonary hypertension prediction model in a unique population and utility in the prediction of long-term survival

Risk Assessment in Pulmonary Arterial Hypertension Patients: The Long and Short of it

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

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