Baseline and Follow-up 6-Min Walk Distance and Brain Natriuretic Peptide Predict 2-Year Mortality in Pulmonary Arterial Hypertension

Fritz, J.S.; Blair, Christiana; Oudiz, Ronald J.; Dufton, Christopher; Olschewski, Horst; Despain, Darrin; Gillies, Hunter; Kawut, Steven M.

doi:10.1378/chest.12-0270

Cited by 92 publications

(96 citation statements)

References 25 publications

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“…Th ese fi ndings are distinctly different from prior studies that demonstrated shorter baseline and posttreatment 6MWD is associated with poorer survival, highlighting the complex relationship between patient-important outcomes and survival. [36][37][38][39][40] Subjects with CTD-PAH were less likely to experience clinically relevant improvement in 6MWD in the current study, a fi nding that has been demonstrated in prior studies. 2,7,41,42 Th is lack of response in CTD-PAH is oft en attributed to various comorbidities in CTD that may limit the effi cacy of PAH-specifi c agents or may refl ect inadequacy of currently used outcome measures for PAH in CTD-associated disease.…”

Section: Discussionsupporting

confidence: 74%

Sex Differences in Response to Tadalafil in Pulmonary Arterial Hypertension

Mathai

Hassoun

Puhan

et al. 2015

Chest

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BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive disease with high rates of morbidity and mortality. Current therapies improve symptoms, functional capacity, and, in select cases, survival. Little is known about patient factors that may predict the likelihood of patient-important, clinically relevant responses to therapy such as the 6-min walk distance (6MWD) and health-related quality of life (HRQoL).

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Section: Discussionsupporting

confidence: 74%

Sex Differences in Response to Tadalafil in Pulmonary Arterial Hypertension

Mathai

Hassoun

Puhan

et al. 2015

Chest

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“…Our results postulate that at least the initial absolute walking distance provides a meaningful prognostic implication for patients with PAH. This notion is supported by findings from a recent study by FRITZ et al [27]. However, no statement about the prognostic power of differences in 6-MWT can be derived from this study.…”

Section: Discussionsupporting

confidence: 56%

“…With the exception of the registration trial for macitentan, a new dual endothelin antagonist, the 6-MWT has been used as the primary end-point in registration trials for all PAH medications [23][24][25][26]. However, recent publications have criticised the application of the 6-MWT as a primary end-point, indicating that changes in 6-MWT might not reflect benefits in outcome, and proposed new end-points such as time to clinical worsening [27][28][29][30]. Our results postulate that at least the initial absolute walking distance provides a meaningful prognostic implication for patients with PAH.…”

Section: Discussionmentioning

confidence: 99%

Novel biomarkers for risk stratification in pulmonary arterial hypertension

et al. 2016

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Risk stratification in pulmonary arterial hypertension (PAH) is paramount to identifying individuals at highest risk of death. So far, there are only limited parameters for prognostication in patients with PAH.95 patients with confirmed PAH were included in the present analysis and followed for a total of 4 years. Blood samples were analysed for serum levels of N-terminal pro-brain natriuretic peptide, highsensitivity troponin T (hsTnT), pro-atrial natriuretic peptide ( proANP), growth differentiation factor 15, soluble fms-like tyrosine kinase 1 and placental growth factor. 27 (28.4%) patients died during a follow-up of 4 years. Levels of all tested biomarkers, except for placental growth factor, were significantly elevated in nonsurvivors compared with survivors. Receiver operating characteristic analyses demonstrated that cardiac biomarkers had the highest power in predicting mortality. In particular, proANP exhibited the highest area under the curve, followed by N-terminal probrain natriuretic peptide and hsTnT. Furthermore, proANP and hsTnT added significant additive prognostic value to the established markers in categorical and continuous net reclassification index. Moreover, after Cox regression, proANP (hazard ratio (HR) 1.91), hsTnT (HR 1.41), echocardiographic right ventricular impairment (HR 1.30) and 6-min walk test (HR 0.97 per 10 m) remained the only significant parameters in prognostication of mortality.Our data suggest benefits of the implementation of proANP and hsTnT as additive biomarkers for risk stratification in patients with PAH. @ERSpublications The cardiac biomarkers proANP and hsTnT may be of use in the assessment of risk stratification in PAH patients http://ow.ly/RJFtn

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“…It retains significance in multivariate analyses even when other strong predictors are included such as patient demographics [127,140], baseline haemodynamics from right heart catheterisation or CMR [140,142,143], CPET variables [92,113] and presence of pericardial effusion [127]. Absolute values of 6MWD measured following PAH treatment retain prognostic power but do not improve on the baseline measurement [144]. The prognostic power is reduced and may be lost in cases of associated PAH such as connective tissue disease [37,92].…”

Section: Field Exercise Testsmentioning

confidence: 99%

“…Although Δ6MWD correlates with change in haemodynamics following PAH treatment [130], it has proven very difficult to demonstrate any prognostic power of Δ6MWD with therapy despite being sought by several studies and meta-analyses [17,141,142,144,147]. The mechanism of this phenomenon has been explored recently by two further studies.…”

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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Baseline and Follow-up 6-Min Walk Distance and Brain Natriuretic Peptide Predict 2-Year Mortality in Pulmonary Arterial Hypertension

Abstract: 6MWD and BNP values at baseline or week 12 identifi ed a population with an elevated risk of death at 2 years. A repeat assessment of 6MWD or BNP after 12 weeks of ambrisentan therapy did not provide additional prognostic information beyond that obtained from baseline values.

Cited by 92 publications

References 25 publications

Sex Differences in Response to Tadalafil in Pulmonary Arterial Hypertension

Sex Differences in Response to Tadalafil in Pulmonary Arterial Hypertension

Novel biomarkers for risk stratification in pulmonary arterial hypertension

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

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