exercise testing oxygen uptake pulmonary hypertension ■ PURPOSE: To determine whether the 6-minute walk test (6MWT) is a predictor of peak oxygen uptake (Vo 2 ) in patients with idiopathic pulmonary arterial hypertension (IPAH).■ METHODS: A total of 157 patients treated for IPAH completed a 6MWT in accordance with American Thoracic Society standards. Heart rate, pulse oximetry, and Borg rating of perceived exertion were determined at baseline and posttest. A cardiopulmonary exercise test (CPET) was performed on a cycle ergometer using a ramp protocol. Participants were stratified post hoc by age into 3 groups: children (n = 26), adolescents (n = 49), and adults (n = 82). Multiple linear regression analysis was performed to predict peak Vo 2 from the 6MWT.■ RESULTS: The regression equation generated for the children was the only model to strongly predict peak Vo 2 (r = 0.87; P < .001). Similar models for adolescent (r = 0.59; P < .001) and adult groups (r = 0.68; P < .001) did not achieve the same level of correlation.■ CONCLUSION: Six-Minute Walk Test was able to accurately predict peak Vo 2 in children (6-12 years) with IPAH; however, the model was weaker for predicting peak Vo 2 in older populations. These findings suggest that 6MWT may be as valid a test for predicting peak Vo 2 in children with IPAH as CPET measured peak Vo 2 . In older IPAH populations, CPET is the only reliable method for the evaluation of peak Vo 2 . The cardiopulmonary response to exercise is an important clinical assessment tool, as it provides an integrated assessment of the respiratory, cardiac, and metabolic systems. The current gold standard method for assessing aerobic exercise response in humans is the maximum incremental cardiopulmonary exercise test (CPET). Peak V o 2 , measured by a CPET, has been widely used to assess functional capacity and predict survival in patients with advanced symptomatic heart failure and respiratory dysfunction. 1,2 However, CPET requires the use of expensive equipment and trained medical team supervision to conduct and evaluate each test. Submaximal tests, like the 6-minute walk test (6MWT), provide useful information on daily physical performance that are safe, simple, standardized, and inexpensive. The 6MWT offers a better estimation of daily living activities than other walk tests 3 and the American Thoracic Society has endorsed and published guidelines for performing the 6MWT in clinical settings. 4
(No relationships reported)Cardiopulmonary Exercise Test (CPET) and Six-minute walk test (6MWT) are important tools in the evaluation and follow up of patients with Idiopathic Pulmonary Arterial Hypertension (IPAH). PURPOSE: To determine if the simple Six-minute walk test (6MWT) is a valid predictor of VO2 peak in patients with IPAH. METHODS: 157 patients being treated for IPAH from 2003 to 2013 were included in this study. A 6MWT and a Cardiopulmonary Exercise Test (CPET) were performed as part of routine care. The 6MWT was conducted in accordance with American Thoracic Society (ATS) standards, using a 30m hallway. Heart rate (HR), pulse oximetry (SpO2) via finger probe and Borg's rate of perceived exertion (RPE) were measured at baseline and post-test. The CPET was performed on a cycle ergometer using a ramp protocol. Electrocardiogram (EKG), analysis of expired air, SpO2, and blood pressure (BP) were monitored throughout the CPET. Subjects were stratified post-hoc by age (26 children=6-12 mean age 9.96±1.66, 73% female 27% male ; 49 adolescents=13-18 mean age 15.33±1.86, 47% female 53% male; 82 adults=>19 mean age 27.33±6.70, 69.5% female 30.5% male), for between-group comparison of anthropometric and 6MWT variables. Multiple linear regression analysis was performed to predict VO2 peak for each of the groups from the 6MWT. RESULTS: The regression equation generated for the children group (VO2 peak= 38.853 + 4.847xGender -0.073Height -0.293xWeight +15.022xSpeed (m/s) -1.153xDyspnea (Borg 1-10) -0.175xResting HR) was the only model to significantly predict VO2 peak (r2=0.80, p=0.804). Similar models for the adolescent and adult groups did not achieve statistical significance (r2=0.39, p=0.142 and r2=0.38, p=0.025, respectively) CONCLUSION: The measured VO2 peak of the patient population varied greatly by age. A 6MWT was able to accurately predict VO2 peak in children (6-12 years) with IPAH, however the model failed to predict VO2 peak in older populations. These findings suggest that CPET measured VO2 peak is the only reliable method for the evaluation of all patients with IPAH.
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