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Six-minute walking test and cardiopulmonary exercise test in pulmonary hypertension risk assessment
Session:
SESSÃO DE POSTERS 13 - CONGÉNITOS E HTP 1
Speaker:
Débora Repolho
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Débora Repolho; Filipa Ferreira; Otilia Simões; Ana Sofia Alegria; Ana Claudia Vieira; Barbara Ferreira; João Luz; Helder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction</strong><br /> Pulmonary Hypertension (PH) leads to a progressive decline in functional capacity, necessitating thorough evaluation and, when possible, quantification. The 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) are recommended for risk assessment at diagnosis, alongside other variables. During follow-up, a simplified 4-strata tool includes three basic variables such as the 6MWT but excludes CPET. Additionally, CPET is rarely used as an endpoint in clinical trials, raising critical questions about its role in clinical practice.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Objective</strong><br /> To evaluate the agreement between risk levels determined by 6MWT and CPET and to assess the correlation of 6MWT and CPET with other variables used in the 4-strata follow-up risk assessment: N-terminal pro-brain natriuretic peptide (NT-proBNP) and World Health Organization (WHO) Functional Class (FC).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong><br /> This retrospective, cross-sectional study included patients from a pulmonary hypertension clinic who during follow-up, underwent 6MWT, CPET, NT-proBNP measurement, and WHO FC assessment within the same period, without changes in their therapeutic regimen. The 6MWT was conducted following ATS 2002 guidelines, and CPET was performed on a treadmill. Correlations were analyzed using Pearson’s or Spearman’s tests based on sample normality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results</strong><br /> A total of 41 patients were included, 63% with pulmonary arterial hypertension (PAH) and 37% with chronic thromboembolic pulmonary hypertension (CTEPH). The cohort was 75.6% female, with a mean age of 48±15 years. WHO FC distribution was: I - 46.3%; II - 36.6%; III - 17.1%; IV -0. Median NT-proBNP was 166 (IQR 118-318 pg/mL). Although 6MWT correlated with CPET (<em><span style="font-family:"Calibri",sans-serif">r<sub>s</sub></span></em> = 0.382; p = 0.014), the agreement between their risk levels was not verified. There is limited discriminatory power of 6MWT in patients walking over 440 meters, where CPET often classified these patients at higher risk (Figure 1 A). Conversely, some patients with limited 6MWT performance had lower CPET risk levels, likely reflecting limitations unrelated to pulmonary hypertension. Stronger correlations were found between FC and % predicted 6MWT distance compared to absolute distance (<em><span style="font-family:"Calibri",sans-serif">r<sub>s</sub></span></em> = -0.515; p = 0.001 vs. <em><span style="font-family:"Calibri",sans-serif">r<sub>s</sub></span></em> = -0.362; p = 0.02). Moderate correlations were observed between FC and predicted peak VO<sub>2</sub> (<em><span style="font-family:"Calibri",sans-serif">r<sub>s</sub></span></em> = -0.515; p = 0.001). NT-proBNP showed no significant correlations with either 6MWT distance or peak CPET, possibly due to the younger age and low-risk profile of the cohort.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif">Conclusions</span></span></strong><br /> <span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif">These findings highlight that there is still a place for CPET in risk stratification at follow-up particularly in low-risk patients and in patients with low functional capacity not in line with the rest of the assessment. The distance alone at 6MWT provides limited data and percentage of predicted distance correlates better with FC. </span></span></p>
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