Six-Minute Walk Test for the Evaluation of Pulmonary Disease Severity in Scleroderma Patients

Villalba, Wander O.; Sampaio-Barros, Percival D.; Pereira, Mônica Corso; Cerqueira, Elza Maria Figueiras Pedreira de; Leme, Cid A.; Marques-Neto, João Francisco; Paschoal, Ilma Aparecida

doi:10.1378/chest.06-0630

Cited by 95 publications

(86 citation statements)

References 30 publications

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“…Other studies have shown that oxygen desaturation during the 6-minute walk test is associated with mortality in patients with primary pulmonary hypertension 35 and reflects pulmonary disease severity in those with secondary pulmonary hypertension. 36 The associations of high jet velocity with a history of acute chest syndrome or blood transfusions and with oxygen desaturation during the 6-minute walk test suggest that children with elevated jet velocity may be at high risk of increased complications in later decades of life. Further investigations are, therefore, needed to clarify the clinical consequences of elevated jet velocity in children and adolescents, and to determine whether early intervention may prevent morbidity and early mortality.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation

Minniti¹,

Sable²,

Campbell³

et al. 2009

Haematologica

160

136

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BackgroundElevation of echocardiography-determined tricuspid regurgitant jet velocity predicts high systolic pulmonary artery pressure and early mortality in adults with sickle cell disease. The definition, prevalence and clinical correlates of elevated jet velocity have not been established in pediatric patients. The present study tested the hypotheses that elevated jet velocity affects 10% of pediatric patients, is associated with both hemolysis and hypoxia, and has clinical correlates with acute chest syndrome, stroke, transfusion requirement and abnormal 6-minute walk test results. Design and MethodsA prospective multicenter study of 310 patients aged 3-20 years old with sickle cell disease under basal conditions and 54 matched controls was conducted. A hemolytic index was generated by principal component analysis of the levels of lactate dehydrogenase, aspartate aminotransferase and bilirubin and reticulocyte count. ResultsElevated jet velocity (defined as ≥2.60 m/sec based on the mean±2 SD in controls) occurred in 32 patients (11.0%) including one child of 3 years old. After adjustment for hemoglobin concentration, systolic blood pressure and left ventricular diastolic function, a 2 SD increase in the hemolytic index was associated with a 4.5-fold increase in the odds of elevated jet velocity (p=0.009) and oxygen saturation ≤98% with a 3.2-fold increase (p=0.028). Two or more episodes of acute chest syndrome had occurred in 28% of children with elevated jet velocity compared to in 13% of other children (p=0.012), more than ten units of blood had been transfused in 39% versus 18% (p=0.017) and stroke had occurred in 19% versus 11% (p=0.2). The distance walked in 6-minute walk tests did not differ significantly, but oxygen saturation declined during the tests in 68% of children with elevated jet velocity compared to in 32% of other children (p=0.0002). ConclusionsAccording to a pediatric-specific definition the prevalence of elevated jet velocity in this population of young patients with sickle cell disease was 11%. The study provides evidence for independent associations of elevated jet velocity with hemolysis and oxygen desaturation. Further investigations should address whether elevated jet velocity may indicate future complications and whether early intervention is beneficial.Key words: sickle cell disease, pulmonary hypertension, hemolysis, oxygen saturation, tricuspid regurgitant jet velocity, children.Citation: Minniti CP, Sable C, Campbell A, Rana S, Ensing G, Dham N, Onyekwere O, Nouraie M, Kato GJ, Gladwin MT, Castro OL, and Gordeuk VR. Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation. Haematologica 2009; 94:340-347. doi:10.3324/haematol.13812 ©2009 Ferrata Storti Foundation.

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Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 99%

Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation

Minniti¹,

Sable²,

Campbell³

et al. 2009

Haematologica

160

136

View full text Add to dashboard Cite

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“…Little information has been obtained on the correlation between lung parameters and exercise-induced oxygen desaturation in systemic sclerosis, though FVC previously showed a significant association with induced oxygen desaturation during 6MWT. 7 Percent-of-predicted D LCO has been reported to be a predictor of 6MWT distance in patients with systemic sclerosis and interstitial lung disease. 4 Exercise-induced oxygen desaturation in patients with idiopathic interstitial pneumonia correlates with walk velocity, percent-of-predicted D LCO and arterial oxygen pressure, 14 percent-of-predicted D LCO and pulmonary capillary blood volume, 3 and D LCO .…”

Section: Discussionmentioning

confidence: 97%

“…6 However, S pO 2 decrease of Ն 4% during 6MWT correlates with age, dyspnea index, positive anti-Scl-70 autoantibody, and FVC, but D LCO has not been examined in relation to oxygen saturation in patients with systemic sclerosis. 7 Identifying predictors of exercise-induced oxygen desaturation would help to select patients who might benefit from additional monitoring using oximetry during 6MWT when oxygen saturation is normal at rest. Moreover, the suggestion of cutoff points for these predictors would help alert patients to avoid hypoxic risk.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Exercise-Induced Oxygen Desaturation in Systemic Sclerosis Patients With Interstitial Lung Disease

Someya

Mugii²,

Hasegawa

et al. 2013

Respir Care

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BACKGROUND:The diffusion capacity of the lung for carbon monoxide (D LCO ) is a good marker of disease severity in patients with idiopathic interstitial pneumonia, and is associated with oxygen saturation; however, little is known about D LCO in systemic sclerosis patients with interstitial lung disease. We studied potential predictors of exercise-induced oxygen desaturation in patients with systemic sclerosis. METHODS: Data were collected prospectively from 80 of 110 consecutive systemic sclerosis patients with normal oxygen saturation (> 95%) at rest, who could perform the 6-min walk test without physical discomfort, including leg pain. Pulmonary function tests and echocardiography were collected from all subjects. RESULTS: Thirty subjects showed a > 4% decline in oxygen saturation during the 6-min walk test (desaturation group). The other subjects were assigned to the normoxic group. The percent-of-predicted values for FVC, FEV 1 , total lung capacity, D LCO , and D LCO /alveolar volume were lower, and FEV 1 /FVC was higher, in the desaturation group. Logistic regression analysis showed the percent-of-predicted D LCO as a highly accurate predictor of exercise-induced oxygen desaturation: the area under the receiver operating characteristic curve was 0.92 (cutoff point 56.3%, sensitivity 0.83, specificity 0.86). Five subjects over the cutoff point of the percent-of-predicted D LCO in the desaturation group could not be distinguished from the normoxic subjects with the lung-volume measurements or right-ventricular systolic pressure. CONCLUSIONS: The factor underlying exercise-induced oxygen desaturation appeared to be reduced percent-of-predicted D LCO , which was useful as a predictor in over 80% of the subjects.

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“…La capacidad de ejercicio evaluada por la distancia recorrida en la prueba de caminata de 6 min fue menor a 400 metros para ambos grupos, con y sin HAP grave, a pesar de la gravedad de la HAP no hubo diferencia en distancia recorrida para ambos grupos. Villalba et al 10 , describieron a la caminata de 6 min menor a 400 metros como factor independiente de mortalidad en pacientes con HAP asociada a escleroderma. El 51% de enfermos en nuestro estudio presentaron restricción pulmonar con CVF disminuida en ambos grupos, a pesar de ello no se encontró deterioro en el intercambio gaseoso, una probable explicación a éste hallazgo es la posible presencia de enfermedad pulmonar intersticial descrita en pacientes con HAP asociada a ETC (18,1%) 11 .…”

Section: Discussionunclassified

Hipertensión arterial pulmonar por ecocardiografía en pacientes con enfermedades de tejido conectivo

et al. 2013

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(85.7 and 52.3% respectively, p = 0.04), right ventricular hypertrophy (42.8 and 0% respectively, p = 0.02) and right ventricular hypokinesia (71.4 and 9.5% respectively p = < 0.01). Conclusions: Patients with severe pulmonary arterial hypertension associated to connective tissue diseases have more commonly dilated, hypertrophic and hypokinetic right ventricles. (Rev Med Chile 2013; 141: 58-62).

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Six-Minute Walk Test for the Evaluation of Pulmonary Disease Severity in Scleroderma Patients

Cited by 95 publications

References 30 publications

Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation

Elevated tricuspid regurgitant jet velocity in children and adolescents with sickle cell disease: association with hemolysis and hemoglobin oxygen desaturation

Predictors of Exercise-Induced Oxygen Desaturation in Systemic Sclerosis Patients With Interstitial Lung Disease

Hipertensión arterial pulmonar por ecocardiografía en pacientes con enfermedades de tejido conectivo

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