Utility of the breath-holding test in patients with systemic sclerosis

Abstract

Objectives Cardiopulmonary involvement is a major cause of death in patients with systemic sclerosis (SSc). This study evaluated the clinical utility and reliability of breath-holding test (BHT) in evaluating cardiopulmonary function in patients with SSc. Methods Seventy-two prospectively enrolled patients with SSc underwent BHT and the 6 min walk test (6MWT), along with measurements of Borg dyspnea scale and Scleroderma Health Assessment Questionnaire (SHAQ). Data on pulmonary function test and echocardiography were also collected. Validity was assessed based on the correlations between the best BHT and relevant clinical parameters. To assess the reliability of BHT, an additional 31 patients with SSc underwent BHTs twice within 2 week intervals. Results Mean±SD best BHT time was 38.4 ± 15.7 s, and 6MWT distance was 473.5 ± 95.5 m. BHT showed significant correlations with Borg dyspnea scale before (r=-0.367, p< 0.001) and after (r=-0.285, p= 0.016) testing, whereas 6MWT were correlated with Borg dyspnea scale after (r=-0.351, p= 0.002) but not before (r=-0.113, p= 0.343) testing. BHT time was correlated with diffusing capacity for carbon monoxide (%, r = 0.426, p< 0.001), forced vital capacity (L, r = 0.373, p= 0.001), pulmonary arterial systolic pressure (mmHg, r=-0.272, p= 0.031) and SHAQ score (r=-0.470, p< 0.001), but not with left ventricular ejection fraction (%, r=-0.135, p= 0.263). BHT showed excellent reliability, with an intraclass correlation coefficient (2, 1) of 0.943 (95% CI = 0.88–0.97). Conclusion BHT, a simple and less time-consuming test, shows excellent reliability and significant correlation with Borg scale, SHAQ, and pulmonary parameters. These results suggest that BHT might be a useful surrogate marker of pulmonary capacity in SSc patients. Trial registration number NCT04484948.

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Wavelet Analysis of Respiratory Muscle sEMG Signals during the Physiological Breakpoint of Static Dry End-Expiratory Breath-Holding in Naive Apneists: A Pilot Study

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