Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension

Badagliacca, Roberto; Rischard, Franz; Giudice, Francesco Lo; Howard, Luke; Papa, S.; Valli, Gabriele; Manzi, Giovanna; Sciomer, Susanna; Palange, Paolo; Garcia, Joe G.N.; Vanderpool, Rebecca; Rinaldo, Rocco Francesco; Vigo, Beatrice; Insel, Michael; Fedele, Francesco; Vizza, Carmine Dario

doi:10.1016/j.healun.2022.02.021

Cited by 16 publications

(22 citation statements)

References 43 publications

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“…Robust prognostic evidence for peak VO 2 and VE/VCO 2 has been found in three studies, all powered for multivariable analysis [261][262][263]. When associated with SVI, peak VO 2 provided useful information to further stratify patients with PAH at intermediate risk [264]. However, the added value of CPET on top of common clinical and haemodynamic variables remains largely unexplored.…”

Section: Exercise Capacitymentioning

confidence: 90%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

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Section: Exercise Capacitymentioning

confidence: 90%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

Self Cite

990

1,631

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“…15 Recently, CPET has also been used, with stroke volume index, to better identify patients at intermediate risk, although only peak VO 2 expressed in absolute value was the variable included in this assessment. 16 Hence, all of the above prove the usefulness of the CPET in the prognosis of PAH. However, there is currently no consensus on which cut-off points should be used for each parameter to establish the likelihood of PH.…”

Section: Discussionmentioning

confidence: 80%

“…Recently, CPET has also been used, with stroke volume index, to better identify patients at intermediate risk, although only peak VO 2 expressed in absolute value was the variable included in this assessment. 16 …”

Section: Discussionmentioning

confidence: 99%

Lack of concordance between the different exercise test measures used in the risk stratification of patients with pulmonary arterial hypertension

et al. 2022

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In pulmonary arterial hypertension (PAH) patients it is essential to perform a prognostic assessment to optimize the treatment. The aim of this study is to evaluate the risk stratification concordance assessed with different exercise test variables in a cohort of PAH patients. A retrospective analysis was performed using patient data registered in the PAH unit. Only those patients in whom the mean time elapsed between the 6‐min walking test (6MWT) and the cardiopulmonary exercise test (CPET) was a maximum of 6 months were selected. A total of 140 records from 40 patients were finally analyzed. When it came to assessing the concordance between the two exercise tests in the guidelines (CPET and 6MWT), up to 84.3% of the records did not coincide in terms of the risk stratification. Exclusively considering the CPET parameters, most of the records (75%) failed to include all three variables in the same risk category. When analyzing the VO 2 alone, up to 40.7% of the tests yielded different risk classifications depending on whether the parameter was expressed. In conclusion, there is a low concordance between the two proposed exercise tests. These results should be a call for reflection on whether the cut‐off points set for the exercise tests proposed for the current risk stratification are adequate to achieve a correct risk stratification or whether they require an appropriate revision.

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“…9 Its prognostic relevance has been reported in patients with PAH and other cardiovascular diseases, and the guidelines have recommended it as one of the predictive variables for risk assessment. [2][3][4][12][13][14][15][16] Nevertheless, regarding assessment for exercise capacity, 6MWD is utilized more widely because of its convenience. However, as shown in the present study, only a few patients could be categorized into a high-risk stratum of 6MWD, leaving most patients in an intermediate risk.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The prognostic value of those variables has been acknowledged in PAH patients, but there still lack studies investigating the optimal cutoff values of those variables or exploring their corporation with the established prediction strategies. [12][13][14][15][16][17][18][19][20][21] Accordingly, the objectives of our study were to explore the prognostic value of noninvasive variables derived by CPET or echocardiography on the basis of WHO FC, 6MWD and NT-proBNP, and to incorporate those predictive variables in the established risk assessment tool to investigate their incremental prognostic value in patients with PAH.…”

Section: Introductionmentioning

confidence: 99%

Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension

et al. 2022

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Risk assessment for pulmonary arterial hypertension (PAH) utilizing noninvasive prognostic variables could be more practical in real-world scenarios, especially at follow-up reevaluations. Patients who underwent comprehensive evaluations both at baseline and at follow-up visits were enrolled. The primary endpoint was all-cause mortality. Predictive variables identified by Cox analyses were further incorporated with the French noninvasive risk prediction approach. A total of 580 PAH patients were enrolled. During a median follow-up time of 47.0 months, 112 patients (19.3%) died. By multivariate Cox analyses, tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary arterial systolic pressure (PASP), and cardiopulmonary exercise testing-derived peak oxygen consumption (VO 2 ) remained independent predictors for survival. Regarding the French noninvasive risk prediction method, substituting N-terminal pro-b-type natriuretic peptide (NT-proBNP) with the newly derived low-risk criteria of a TAPSE ≥ 17 mm or a TAPSE/PASP > 0.17 mm/mmHg, or alternating 6-min walking distance with a peak VO 2 ≥ 44 %predicted retained the discrimination power. When recombining the low-risk criteria, the combination of World Health Organization functional class (WHO FC), TAPSE and peak VO 2 at baseline, and the combination of WHO FC, NT-proBNP, and peak VO 2 at follow-up showed better discriminative ability than the other combinations. In

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Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension

Cited by 16 publications

References 43 publications

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Lack of concordance between the different exercise test measures used in the risk stratification of patients with pulmonary arterial hypertension

Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension

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