Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension
Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing in this setting remains undefin...
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| Veröffentlicht in: | The Journal of heart and lung transplantation 2022-06, Vol.41 (6), p.780-790 |
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| container_title | The Journal of heart and lung transplantation |
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| creator | Badagliacca, Roberto Rischard, Franz Giudice, Francesco Lo Howard, Luke Papa, Silvia Valli, Gabriele Manzi, Giovanna Sciomer, Susanna Palange, Paolo Garcia, Joe G.N. Vanderpool, Rebecca Rinaldo, Rocco Vigo, Beatrice Insel, Michael Fedele, Francesco Vizza, Carmine Dario |
| description | Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing in this setting remains undefined.
Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Cross-validation on the overall population was used to strengthen the results of the analysis. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. Discrimination and calibration were assessed.
A risk score was constructed based on the beta-coefficient of the cross-validated model, including the stroke volume index (SVI) and the peak oxygen uptake (VO2 peak). Patients were grouped based on cutoff values of the risk score allowing the highest discrimination in the overall cohort. Group 1, score ≤2 (101 patients) with VO2 peak ≥14 ml/kg/min and SVI >30 ml/m2; Group 2, score between 2 and 5 (112 patients) with VO2 peak between 9 and 14 ml/kg/min, and SVI between 20 and 50 ml/m2; Group 3, score >5 (46 patients) with VO2 peak |
| doi_str_mv | 10.1016/j.healun.2022.02.021 |
| format | Article |
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Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Cross-validation on the overall population was used to strengthen the results of the analysis. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. Discrimination and calibration were assessed.
A risk score was constructed based on the beta-coefficient of the cross-validated model, including the stroke volume index (SVI) and the peak oxygen uptake (VO2 peak). Patients were grouped based on cutoff values of the risk score allowing the highest discrimination in the overall cohort. Group 1, score ≤2 (101 patients) with VO2 peak ≥14 ml/kg/min and SVI >30 ml/m2; Group 2, score between 2 and 5 (112 patients) with VO2 peak between 9 and 14 ml/kg/min, and SVI between 20 and 50 ml/m2; Group 3, score >5 (46 patients) with VO2 peak <10 ml/kg/min and SVI <30 ml/m2. The event-free survival rates at 1, 2 and 3 years, were 96%, 83% and 79% for Group 1, respectively; 82%, 67% and 52% for Group 2; 69%, 50% and 41% for Group 3.
Combinations of VO2 peak and SVI may provide important information to further stratify intermediate-risk prevalent patients with idiopathic PAH.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2022.02.021</identifier><identifier>PMID: 35414469</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>cardiopulmonary exercise test ; clinical worsening ; oxygen uptake ; pulmonary arterial hypertension ; validation</subject><ispartof>The Journal of heart and lung transplantation, 2022-06, Vol.41 (6), p.780-790</ispartof><rights>2022 International Society for Heart and Lung Transplantation</rights><rights>Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-38a83da6b5fe216eea178f2b15573a82286bde823f3cd19ea17f623de735981d3</citedby><cites>FETCH-LOGICAL-c408t-38a83da6b5fe216eea178f2b15573a82286bde823f3cd19ea17f623de735981d3</cites><orcidid>0000-0003-0676-3132 ; 0000-0001-8653-4035 ; 0000-0003-3999-5298</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1053249822018447$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35414469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Badagliacca, Roberto</creatorcontrib><creatorcontrib>Rischard, Franz</creatorcontrib><creatorcontrib>Giudice, Francesco Lo</creatorcontrib><creatorcontrib>Howard, Luke</creatorcontrib><creatorcontrib>Papa, Silvia</creatorcontrib><creatorcontrib>Valli, Gabriele</creatorcontrib><creatorcontrib>Manzi, Giovanna</creatorcontrib><creatorcontrib>Sciomer, Susanna</creatorcontrib><creatorcontrib>Palange, Paolo</creatorcontrib><creatorcontrib>Garcia, Joe G.N.</creatorcontrib><creatorcontrib>Vanderpool, Rebecca</creatorcontrib><creatorcontrib>Rinaldo, Rocco</creatorcontrib><creatorcontrib>Vigo, Beatrice</creatorcontrib><creatorcontrib>Insel, Michael</creatorcontrib><creatorcontrib>Fedele, Francesco</creatorcontrib><creatorcontrib>Vizza, Carmine Dario</creatorcontrib><title>Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing in this setting remains undefined.
Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Cross-validation on the overall population was used to strengthen the results of the analysis. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. Discrimination and calibration were assessed.
A risk score was constructed based on the beta-coefficient of the cross-validated model, including the stroke volume index (SVI) and the peak oxygen uptake (VO2 peak). Patients were grouped based on cutoff values of the risk score allowing the highest discrimination in the overall cohort. Group 1, score ≤2 (101 patients) with VO2 peak ≥14 ml/kg/min and SVI >30 ml/m2; Group 2, score between 2 and 5 (112 patients) with VO2 peak between 9 and 14 ml/kg/min, and SVI between 20 and 50 ml/m2; Group 3, score >5 (46 patients) with VO2 peak <10 ml/kg/min and SVI <30 ml/m2. The event-free survival rates at 1, 2 and 3 years, were 96%, 83% and 79% for Group 1, respectively; 82%, 67% and 52% for Group 2; 69%, 50% and 41% for Group 3.
Combinations of VO2 peak and SVI may provide important information to further stratify intermediate-risk prevalent patients with idiopathic PAH.</description><subject>cardiopulmonary exercise test</subject><subject>clinical worsening</subject><subject>oxygen uptake</subject><subject>pulmonary arterial hypertension</subject><subject>validation</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kFtLxDAQhYMo7rr6D0T66EtrLr2kL4IsXhYWfNHnkKZTN7VNa9Iu7r83pV7ehAMZmDMzOR9ClwRHBJP0po52IJvRRBRTGuFJ5AgtSZJkISMkO_Y1TlhI45wv0JlzNcaYsoSeogVLYhLHab5E9cYoCy2YQTbB3u-DoKsCJW2pu35s2s5IewjgE6zSDoIB3KDNW6CN1wC2hVLLAUKr3Xvw55fW97TfuDv04GvjdGfO0UklGwcX3-8KvT7cv6yfwu3z42Z9tw1VjPkQMi45K2VaJBVQkgJIkvGKFlMwJjmlPC1K4JRVTJUkn9pVSlkJGUtyTkq2Qtfz3t52H6P_sGi1U9A00kA3OkHTOM_zlFHirfFsVbZzzkIleqtbn0AQLCbKohYzZTFRFnjSNHb1fWEsPIHfoR-s3nA7G8Dn3GuwwikNRnlaFtQgyk7_f-ELLiKSsg</recordid><startdate>202206</startdate><enddate>202206</enddate><creator>Badagliacca, Roberto</creator><creator>Rischard, Franz</creator><creator>Giudice, Francesco Lo</creator><creator>Howard, Luke</creator><creator>Papa, Silvia</creator><creator>Valli, Gabriele</creator><creator>Manzi, Giovanna</creator><creator>Sciomer, Susanna</creator><creator>Palange, Paolo</creator><creator>Garcia, Joe G.N.</creator><creator>Vanderpool, Rebecca</creator><creator>Rinaldo, Rocco</creator><creator>Vigo, Beatrice</creator><creator>Insel, Michael</creator><creator>Fedele, Francesco</creator><creator>Vizza, Carmine Dario</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0676-3132</orcidid><orcidid>https://orcid.org/0000-0001-8653-4035</orcidid><orcidid>https://orcid.org/0000-0003-3999-5298</orcidid></search><sort><creationdate>202206</creationdate><title>Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension</title><author>Badagliacca, Roberto ; Rischard, Franz ; Giudice, Francesco Lo ; Howard, Luke ; Papa, Silvia ; Valli, Gabriele ; Manzi, Giovanna ; Sciomer, Susanna ; Palange, Paolo ; Garcia, Joe G.N. ; Vanderpool, Rebecca ; Rinaldo, Rocco ; Vigo, Beatrice ; Insel, Michael ; Fedele, Francesco ; Vizza, Carmine Dario</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-38a83da6b5fe216eea178f2b15573a82286bde823f3cd19ea17f623de735981d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>cardiopulmonary exercise test</topic><topic>clinical worsening</topic><topic>oxygen uptake</topic><topic>pulmonary arterial hypertension</topic><topic>validation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Badagliacca, Roberto</creatorcontrib><creatorcontrib>Rischard, Franz</creatorcontrib><creatorcontrib>Giudice, Francesco Lo</creatorcontrib><creatorcontrib>Howard, Luke</creatorcontrib><creatorcontrib>Papa, Silvia</creatorcontrib><creatorcontrib>Valli, Gabriele</creatorcontrib><creatorcontrib>Manzi, Giovanna</creatorcontrib><creatorcontrib>Sciomer, Susanna</creatorcontrib><creatorcontrib>Palange, Paolo</creatorcontrib><creatorcontrib>Garcia, Joe G.N.</creatorcontrib><creatorcontrib>Vanderpool, Rebecca</creatorcontrib><creatorcontrib>Rinaldo, Rocco</creatorcontrib><creatorcontrib>Vigo, Beatrice</creatorcontrib><creatorcontrib>Insel, Michael</creatorcontrib><creatorcontrib>Fedele, Francesco</creatorcontrib><creatorcontrib>Vizza, Carmine Dario</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Badagliacca, Roberto</au><au>Rischard, Franz</au><au>Giudice, Francesco Lo</au><au>Howard, Luke</au><au>Papa, Silvia</au><au>Valli, Gabriele</au><au>Manzi, Giovanna</au><au>Sciomer, Susanna</au><au>Palange, Paolo</au><au>Garcia, Joe G.N.</au><au>Vanderpool, Rebecca</au><au>Rinaldo, Rocco</au><au>Vigo, Beatrice</au><au>Insel, Michael</au><au>Fedele, Francesco</au><au>Vizza, Carmine Dario</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2022-06</date><risdate>2022</risdate><volume>41</volume><issue>6</issue><spage>780</spage><epage>790</epage><pages>780-790</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing in this setting remains undefined.
Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Cross-validation on the overall population was used to strengthen the results of the analysis. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. Discrimination and calibration were assessed.
A risk score was constructed based on the beta-coefficient of the cross-validated model, including the stroke volume index (SVI) and the peak oxygen uptake (VO2 peak). Patients were grouped based on cutoff values of the risk score allowing the highest discrimination in the overall cohort. Group 1, score ≤2 (101 patients) with VO2 peak ≥14 ml/kg/min and SVI >30 ml/m2; Group 2, score between 2 and 5 (112 patients) with VO2 peak between 9 and 14 ml/kg/min, and SVI between 20 and 50 ml/m2; Group 3, score >5 (46 patients) with VO2 peak <10 ml/kg/min and SVI <30 ml/m2. The event-free survival rates at 1, 2 and 3 years, were 96%, 83% and 79% for Group 1, respectively; 82%, 67% and 52% for Group 2; 69%, 50% and 41% for Group 3.
Combinations of VO2 peak and SVI may provide important information to further stratify intermediate-risk prevalent patients with idiopathic PAH.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35414469</pmid><doi>10.1016/j.healun.2022.02.021</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-0676-3132</orcidid><orcidid>https://orcid.org/0000-0001-8653-4035</orcidid><orcidid>https://orcid.org/0000-0003-3999-5298</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | cardiopulmonary exercise test clinical worsening oxygen uptake pulmonary arterial hypertension validation |
| title | Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension |
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