Exercise-Induced Oxygen Desaturation and Heart Rate Response During 6-Min Walk Test Predict Pulmonary Hypertension in Exertional Dyspnea: A Retrospective Cohort Study.
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引用次数: 0
Abstract
Pulmonary hypertension (PH) is a life-threatening condition frequently associated with exertional dyspnea. It remains diagnostically challenging due to limitations in current screening modalities. While the 6-min walk test (6MWT) has been applied for risk stratification in confirmed PH, its potential role in screening remains unexplored. This retrospective cohort study investigated the diagnostic utility of 6MWT-derived parameters in 180 patients with exertional dyspnea. PH diagnosis was confirmed by right heart catheterization with the definition of mean pulmonary artery pressure > 20 mmHg. Among 79 PH patients (43.9%), a significantly reduced 6-min walk distance (6MWD) was observed compared to non-PH patients (469.5 ± 106.4 m vs. 509.8 ± 74.9 m, p = 0.019). Continuous physiological monitoring revealed that the SpO₂ trough and the heart rate (HR) peak occurred at different time points during 6MWT. Propensity score-matched case-control analysis further demonstrated greater exercise-induced desaturation of SpO2 from the rest to minimal levels (ΔSpO₂rest-min: 9 ± 9% vs. 4 ± 6%, p < 0.001) and exaggerated HR response from the rest to maximal levels (ΔHRmax-rest: 51±21bpm vs. 34±14bpm, p < 0.001) in PH patients. Multivariable analysis identified ΔSpO₂rest-min ≥ 5% (AUC = 0.715, 95% CI: 0.640-0.852; p < 0.001) and ΔHRmax-rest ≥ 42 bpm (AUC = 0.740, 95% CI: 0.656-0.823; p < 0.001) as independent predictors of PH. The number of these predictors discriminated the risk of PH in dyspneic patients. A risk-stratification model incorporating these thresholds demonstrated improved predictive value for PH screening, with a C-statistic of 0.786 (95% CI: 0.710-0.863, p < 0.001). These findings suggest that parameters derived from the 6MWT, particularly exercise-induced SpO₂ desaturation and HR response, may facilitate noninvasive PH screening in exertional dyspneic patients.
期刊介绍:
Pulmonary Circulation''s main goal is to encourage basic, translational, and clinical research by investigators, physician-scientists, and clinicans, in the hope of increasing survival rates for pulmonary hypertension and other pulmonary vascular diseases worldwide, and developing new therapeutic approaches for the diseases. Freely available online, Pulmonary Circulation allows diverse knowledge of research, techniques, and case studies to reach a wide readership of specialists in order to improve patient care and treatment outcomes.