Validação de um protocolo para o teste de caminhada de seis minutos em esteira para avaliação de pacientes com hipertensão arterial pulmonar

Abstract

Objective: To develop and validate a protocol for the treadmill six-minute walk test (tread6MWT) to evaluate patients with pulmonary arterial hypertension (PAH). Methods: The study population comprised 73 patients with PAH, diagnosed by means of right heart catheterization, with or without NO inhalation. All patients performed a hallway 6MWT and three tread6MWTs based on a pre-determined incremental speed protocol and interposed by a rest period. The patients who had been submitted to hemodynamic testing using NO performed the third tread6MWT while inhaling the same dose of NO that had been used during the catheterization. Results: We found that the treadmill six-minute walk distance (tread6MWD) correlated with hemodynamic data, functional class and the hallway six-minute walk distance (6MWD). In addition, the tread6MWD correlated significantly with survival, thereby confirming the correlation with disease severity. Inhalation of NO during the tread6MWT led to variations that were consistent with the hemodynamic changes induced by the same dose of inhaled NO, suggesting that the protocol developed can reflect the effect of therapeutic interventions. Conclusions: We conclude that the tread6MWD is a useful prognostic and functional marker for the routine evaluation of PAH patients.Keywords: Hypertension, pulmonary; Exercise test; Hemodynamics. ResumoObjetivo: Elaborar e validar um protocolo para teste de caminhada de seis minutos em esteira (TC6est) para a avaliação de pacientes com hipertensão arterial pulmonar (HAP). Métodos: A população do estudo foi composta por 73 pacientes com HAP diagnosticados através de cateterismo cardíaco direito, com ou sem inalação de NO. Todos os pacientes realizaram um TC6 em solo e três TC6est baseados em um protocolo de incremento de velocidade pré-determinado e intercalados por um período de repouso. Os pacientes que haviam realizado o teste hemodinâmico com inalação de NO realizaram o terceiro TC6est com a inalação da mesma dose de NO utilizada durante o cateterismo. Resultados: Os resultados mostraram uma correlação da distância caminhada no TC6est com os dados hemodinâmicos, assim como com a classe funcional e com a distância caminhada no solo. Além disso, a distância percorrida no TC6est apresentou uma correlação significativa com a sobrevida, confirmando, portanto, sua correlação com a gravidade da doença. A inalação de NO durante o TC6est levou a variações compatíveis com as variações hemodinâmicas frente à mesma dose de NO, sugerindo que o protocolo em questão pode refletir o efeito de intervenções terapêuticas. Conclusões: Concluímos que a distância percorrida no TC6est é um marcador funcional e prognóstico na avaliação de rotina de pacientes com HAP.Descritores: Hipertensão pulmonar; Teste de esforço; Hemodinâmica. * Study carried out at the Pulmonary Circulation Outpatient

Effects of non-invasive ventilatory support in tolerance to the effort of patients with hemodialysis

“…During this study, a treadmill walk test protocol was adopted, proposed by Camargo et al (9). An ergometer was used to perform the test because the NIV device available was not portable, making impossible to perform a conventional walk test.…”

“…The irst phase is the execution of an assessment (anamnesis and physical exam) and pulmonary function tests (spirometry and manovacuometry). The other two phases consisted in the execution of a tread6WT in two distinct situations, following the protocol suggested by Camargo et al (9). The initial speed was 2km/h, and may be increased by 1km/h every 30 seconds, depending on the patient tolerance, reaching a maximum of 8km/h, or if requested to be reduced, this would be done in 0,5km/h in every request.…”

“…One way to measure the functional status of patients is to perform a 6-minute walk test (6WT), in addition to providing information regarding cardiorespiratory responses to the exercise (8). This test can be performed on a treadmill (tread6WT) when there is no runner available or the necessity of a more speci ic monitoring of the patient (9).…”

<p>Management of Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis</p>

“…20,41 The six-minute walk test (6MWT) is a non-invasive submaximal functional test that correlates with maximum exercise capacity as measured by CPET. 42 In addition, heart rate recovery (HRR, as measured by the difference of heart rate at the end of 6MWT and after 1 min of resting) may predict clinical worsening in patients with connective tissue disease associated PAH (CTD-PAH), including SSc. 43 However, the performance characteristics of the 6MWT in SSc are less robust than in IPAH secondary to non-cardiopulmonary limitations of exercise, such as joint pain, skin contractures and muscle weakness.…”

Belastungstests bei pulmonal-arterieller Hypertonie

“…Weitere Belastungstests wie der Ausdauer-Shuttle-Gehtest [5], das Naughton-Balke-Protokoll auf dem Laufband [41] oder der 6MGT auf dem Laufband [42] werden bisher nur selten bei PAH eingesetzt.…”