Exercise-Induced Oxygen Desaturation and Heart Rate Response During 6-Min Walk Test Predict Pulmonary Hypertension in Exertional Dyspnea: A Retrospective Cohort Study.

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Pulmonary Circulation Pub Date : 2025-06-25 eCollection Date: 2025-04-01 DOI:10.1002/pul2.70120
Haojie Zhang, Menghuan Yan, Feng Li, Qi Chen, Rui Lu, Ziyu Wang, Xuan Zheng, Gangcheng Zhang
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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.

6分钟步行试验中运动诱导的氧去饱和和心率反应预测运动性呼吸困难患者肺动脉高压:一项回顾性队列研究。
肺动脉高压(PH)是一种危及生命的疾病,通常与用力呼吸困难有关。由于目前筛查方式的限制,它在诊断上仍然具有挑战性。虽然6分钟步行试验(6MWT)已被用于确诊PH的风险分层,但其在筛查中的潜在作用仍未被探索。本回顾性队列研究探讨了6mwt衍生参数在180例运动性呼吸困难患者中的诊断效用。经右心导管确认PH诊断,定义平均肺动脉压> 20 mmHg。在79名PH患者(43.9%)中,与非PH患者相比,6分钟步行距离(6MWD)显著减少(469.5±106.4 m比509.8±74.9 m, p = 0.019)。连续生理监测显示,在6MWT期间,SpO 2低谷和心率(HR)峰值出现在不同的时间点。倾向评分匹配的病例对照分析进一步表明,运动引起的SpO2从静止状态降至最低水平(ΔSpO₂rest -min: 9±9% vs. 4±6%,p max -rest: 51±21bpm vs. 34±14bpm, p rest -min≥5%)(AUC = 0.715, 95% CI: 0.64 -0.852;p马克斯- r≥42 bpm (AUC = 0.740, 95% CI: 0.656—-0.823;p p
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来源期刊
Pulmonary Circulation
Pulmonary Circulation Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.20
自引率
11.50%
发文量
153
审稿时长
15 weeks
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.
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