Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience
Abstract A simplified 4‐strata risk stratification approach based on three variables is widespread in pulmonary arterial hypertension (PAH) at follow‐up. This study aimed to assess the impact of replacing the 6‐min walk test (6MWT) with the peak 02 uptake evaluated by the cardiopulmonary exercise te...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12342 |
| _version_ | 1797236734061182976 |
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| author | Amaya Martínez‐Meñaca Alejandro Cruz‐Utrilla Víctor Manuel Mora‐Cuesta Raquel Luna‐López Teresa Segura‐de la Cal Ángela Flox‐Camacho Pilar Alonso‐Lecue Pilar Escribano‐Subias José Manuel Cifrián‐Martínez |
| author_facet | Amaya Martínez‐Meñaca Alejandro Cruz‐Utrilla Víctor Manuel Mora‐Cuesta Raquel Luna‐López Teresa Segura‐de la Cal Ángela Flox‐Camacho Pilar Alonso‐Lecue Pilar Escribano‐Subias José Manuel Cifrián‐Martínez |
| author_sort | Amaya Martínez‐Meñaca |
| collection | DOAJ |
| description | Abstract A simplified 4‐strata risk stratification approach based on three variables is widespread in pulmonary arterial hypertension (PAH) at follow‐up. This study aimed to assess the impact of replacing the 6‐min walk test (6MWT) with the peak 02 uptake evaluated by the cardiopulmonary exercise test (CPET) on risk stratification by this scale. We included 180 prevalent patients with PAH from two reference hospitals in Spain, followed up between 2006 and 2022. Patients were included if all the variables of interest were available within a 3‐month period on the Spanish Registry of Pulmonary Arterial Hypertension (REHAP): functional class (FC); NT‐proBNP; 6MWT; and CPET. The original 4‐strata model (NT‐proBNP, 6MWT, FC) identified most patients at low or intermediate‐low risk (36.7% and 51.1%, respectively). Notably, the modified scale (NT‐proBNP, CPET, FC) improved the identification of patients at intermediate‐high risk up to 18.9%, and at high risk up to 1.1% in comparison with the previous 12.2% and 0.0% in the original scale. This new model increased the number of patients correctly classified into higher‐risk strata (positive NRI of 0.06), as well as classified more patients without events in lower‐risk strata (negative NRI of 0.04). The proposed score showed a slightly superior prognostic capacity compared with the original model (Harrel's C‐index 0.717 vs. 0.709). Using O2 uptake instead of distance walked in the 6MWT improves the identification of high‐risk patients using the 4‐strata scale. This change could have relevant prognostic implications and lead to changes in the specific treatment of PAH. |
| first_indexed | 2024-04-24T17:08:33Z |
| format | Article |
| id | doaj.art-92750aa284ba48e5af5a195e918c904c |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-24T17:08:33Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-92750aa284ba48e5af5a195e918c904c2024-03-28T19:28:30ZengWileyPulmonary Circulation2045-89402024-01-01141n/an/a10.1002/pul2.12342Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experienceAmaya Martínez‐Meñaca0Alejandro Cruz‐Utrilla1Víctor Manuel Mora‐Cuesta2Raquel Luna‐López3Teresa Segura‐de la Cal4Ángela Flox‐Camacho5Pilar Alonso‐Lecue6Pilar Escribano‐Subias7José Manuel Cifrián‐Martínez8Respiratory Department, ERN‐LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Hospital Universitario Marqués de Valdecilla Santander SpainCardiology Department, ERN‐LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid SpainRespiratory Department, ERN‐LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Hospital Universitario Marqués de Valdecilla Santander SpainCardiology Department, ERN‐LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid SpainCardiology Department, ERN‐LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid SpainCardiology Department, ERN‐LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid SpainIDIVAL (Valdecilla Research Institute) Santander SpainCardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII) Hospital Universitario Doce de Octubre Madrid SpainRespiratory Department, ERN‐LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Facultad de Medicina, Hospital Universitario Marqués de Valdecilla Universidad de Cantabria Santander SpainAbstract A simplified 4‐strata risk stratification approach based on three variables is widespread in pulmonary arterial hypertension (PAH) at follow‐up. This study aimed to assess the impact of replacing the 6‐min walk test (6MWT) with the peak 02 uptake evaluated by the cardiopulmonary exercise test (CPET) on risk stratification by this scale. We included 180 prevalent patients with PAH from two reference hospitals in Spain, followed up between 2006 and 2022. Patients were included if all the variables of interest were available within a 3‐month period on the Spanish Registry of Pulmonary Arterial Hypertension (REHAP): functional class (FC); NT‐proBNP; 6MWT; and CPET. The original 4‐strata model (NT‐proBNP, 6MWT, FC) identified most patients at low or intermediate‐low risk (36.7% and 51.1%, respectively). Notably, the modified scale (NT‐proBNP, CPET, FC) improved the identification of patients at intermediate‐high risk up to 18.9%, and at high risk up to 1.1% in comparison with the previous 12.2% and 0.0% in the original scale. This new model increased the number of patients correctly classified into higher‐risk strata (positive NRI of 0.06), as well as classified more patients without events in lower‐risk strata (negative NRI of 0.04). The proposed score showed a slightly superior prognostic capacity compared with the original model (Harrel's C‐index 0.717 vs. 0.709). Using O2 uptake instead of distance walked in the 6MWT improves the identification of high‐risk patients using the 4‐strata scale. This change could have relevant prognostic implications and lead to changes in the specific treatment of PAH.https://doi.org/10.1002/pul2.12342cardiopulmonary exercise testpulmonary arterial hypertensionrisk assessment6 min walking test |
| spellingShingle | Amaya Martínez‐Meñaca Alejandro Cruz‐Utrilla Víctor Manuel Mora‐Cuesta Raquel Luna‐López Teresa Segura‐de la Cal Ángela Flox‐Camacho Pilar Alonso‐Lecue Pilar Escribano‐Subias José Manuel Cifrián‐Martínez Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience Pulmonary Circulation cardiopulmonary exercise test pulmonary arterial hypertension risk assessment 6 min walking test |
| title | Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience |
| title_full | Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience |
| title_fullStr | Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience |
| title_full_unstemmed | Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience |
| title_short | Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two‐center experience |
| title_sort | simplified risk stratification based on cardiopulmonary exercise test a spanish two center experience |
| topic | cardiopulmonary exercise test pulmonary arterial hypertension risk assessment 6 min walking test |
| url | https://doi.org/10.1002/pul2.12342 |
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