Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
Objectives In chronic thromboembolic pulmonary hypertension, objective data to assess the functional outcome after pulmonary endarterectomy are lacking. We studied the 6-minute walk distance in relation to the clinical and hemodynamic severity of disease, and assessed the effect of pulmonary endarte...
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| creator | Reesink, Herre J., MD van der Plas, Mart N., MSc, RFT Verhey, Niesje E., RFT van Steenwijk, Reindert P., MD Kloek, Jaap J., MD Bresser, Paul, MD, PhD |
| description | Objectives In chronic thromboembolic pulmonary hypertension, objective data to assess the functional outcome after pulmonary endarterectomy are lacking. We studied the 6-minute walk distance in relation to the clinical and hemodynamic severity of disease, and assessed the effect of pulmonary endarterectomy on the 6-minute walk distance. Methods A total of 50 consecutive patients with chronic thromboembolic pulmonary hypertension were studied. Subsequently, pulmonary endarterectomy was performed in 42 patients, 35 of whom underwent a 6-minute walk distance 1 year after surgery. Results The mean ± standard error of the mean 6-minute walk distance was 391 ± 19 m. The 6-minute walk distance decreased in proportion to New York Heart Association functional class and correlated (all P < .0001) with mean pulmonary artery pressure (r = −0.62), cardiac output (r = 0.76), total pulmonary resistance (r = −0.75), mixed venous oxygen saturation (r = 0.77), and brain natriuretic peptide (r = −0.65). One year after pulmonary endarterectomy, the 6-minute walk distance increased from 417 ± 19 m to 517 ± 16 m ( P < .0001). The change from baseline in 6-minute walk distance correlated with the changes after 1 year in New York Heart Association functional class ( P < .01) and brain natriuretic peptide (r = 0.57, P < .002), and with the observed hemodynamic changes directly after pulmonary endarterectomy (change in mean pulmonary artery pressure: r = 0.52; change in cardiac output: r = 0.70; change in total pulmonary resistance r = 0.70; all P < .001). In patients with residual pulmonary hypertension after pulmonary endarterectomy, the 6-minute walk distance was significantly lower than in hemodynamically normalized patients. However, the absolute increase in the 6-minute walk distance was higher in patients with residual pulmonary hypertension (137 ± 26 m and 82 ± 20 m, respectively; P = .03). Conclusions The 6-minute walk distance was demonstrated to reflect the clinical and hemodynamic severity of disease in patients with chronic thromboembolic pulmonary hypertension. One year after pulmonary endarterectomy, the 6-minute walk distance had increased significantly, and the change in the 6-minute walk distance correlated with the observed clinical and hemodynamic improvement. |
| doi_str_mv | 10.1016/j.jtcvs.2006.10.020 |
| format | Article |
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We studied the 6-minute walk distance in relation to the clinical and hemodynamic severity of disease, and assessed the effect of pulmonary endarterectomy on the 6-minute walk distance. Methods A total of 50 consecutive patients with chronic thromboembolic pulmonary hypertension were studied. Subsequently, pulmonary endarterectomy was performed in 42 patients, 35 of whom underwent a 6-minute walk distance 1 year after surgery. Results The mean ± standard error of the mean 6-minute walk distance was 391 ± 19 m. The 6-minute walk distance decreased in proportion to New York Heart Association functional class and correlated (all P < .0001) with mean pulmonary artery pressure (r = −0.62), cardiac output (r = 0.76), total pulmonary resistance (r = −0.75), mixed venous oxygen saturation (r = 0.77), and brain natriuretic peptide (r = −0.65). One year after pulmonary endarterectomy, the 6-minute walk distance increased from 417 ± 19 m to 517 ± 16 m ( P < .0001). The change from baseline in 6-minute walk distance correlated with the changes after 1 year in New York Heart Association functional class ( P < .01) and brain natriuretic peptide (r = 0.57, P < .002), and with the observed hemodynamic changes directly after pulmonary endarterectomy (change in mean pulmonary artery pressure: r = 0.52; change in cardiac output: r = 0.70; change in total pulmonary resistance r = 0.70; all P < .001). In patients with residual pulmonary hypertension after pulmonary endarterectomy, the 6-minute walk distance was significantly lower than in hemodynamically normalized patients. However, the absolute increase in the 6-minute walk distance was higher in patients with residual pulmonary hypertension (137 ± 26 m and 82 ± 20 m, respectively; P = .03). Conclusions The 6-minute walk distance was demonstrated to reflect the clinical and hemodynamic severity of disease in patients with chronic thromboembolic pulmonary hypertension. One year after pulmonary endarterectomy, the 6-minute walk distance had increased significantly, and the change in the 6-minute walk distance correlated with the observed clinical and hemodynamic improvement.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2006.10.020</identifier><identifier>PMID: 17258590</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Chronic Disease ; Cohort Studies ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Endarterectomy - methods ; Endarterectomy - mortality ; Exercise Test - methods ; Female ; Follow-Up Studies ; Humans ; Hypertension, Pulmonary - diagnosis ; Hypertension, Pulmonary - mortality ; Hypertension, Pulmonary - surgery ; Linear Models ; Male ; Medical sciences ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Pneumology ; Postoperative Complications - diagnosis ; Prospective Studies ; Pulmonary Circulation - physiology ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Risk Assessment ; Severity of Illness Index ; Statistics, Nonparametric ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Rate ; Thromboembolism - diagnosis ; Thromboembolism - mortality ; Thromboembolism - surgery ; Time Factors ; Treatment Outcome ; Vascular Patency - physiology ; Walking</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2007-02, Vol.133 (2), p.510-516</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2007 The American Association for Thoracic Surgery</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-8b3e172ce250da8f88cb09ea08e7fd968a2b6e4e84c8a828b36f54e69b369f8f3</citedby><cites>FETCH-LOGICAL-c585t-8b3e172ce250da8f88cb09ea08e7fd968a2b6e4e84c8a828b36f54e69b369f8f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2006.10.020$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18521476$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17258590$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reesink, Herre J., MD</creatorcontrib><creatorcontrib>van der Plas, Mart N., MSc, RFT</creatorcontrib><creatorcontrib>Verhey, Niesje E., RFT</creatorcontrib><creatorcontrib>van Steenwijk, Reindert P., MD</creatorcontrib><creatorcontrib>Kloek, Jaap J., MD</creatorcontrib><creatorcontrib>Bresser, Paul, MD, PhD</creatorcontrib><title>Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objectives In chronic thromboembolic pulmonary hypertension, objective data to assess the functional outcome after pulmonary endarterectomy are lacking. We studied the 6-minute walk distance in relation to the clinical and hemodynamic severity of disease, and assessed the effect of pulmonary endarterectomy on the 6-minute walk distance. Methods A total of 50 consecutive patients with chronic thromboembolic pulmonary hypertension were studied. Subsequently, pulmonary endarterectomy was performed in 42 patients, 35 of whom underwent a 6-minute walk distance 1 year after surgery. Results The mean ± standard error of the mean 6-minute walk distance was 391 ± 19 m. The 6-minute walk distance decreased in proportion to New York Heart Association functional class and correlated (all P < .0001) with mean pulmonary artery pressure (r = −0.62), cardiac output (r = 0.76), total pulmonary resistance (r = −0.75), mixed venous oxygen saturation (r = 0.77), and brain natriuretic peptide (r = −0.65). One year after pulmonary endarterectomy, the 6-minute walk distance increased from 417 ± 19 m to 517 ± 16 m ( P < .0001). The change from baseline in 6-minute walk distance correlated with the changes after 1 year in New York Heart Association functional class ( P < .01) and brain natriuretic peptide (r = 0.57, P < .002), and with the observed hemodynamic changes directly after pulmonary endarterectomy (change in mean pulmonary artery pressure: r = 0.52; change in cardiac output: r = 0.70; change in total pulmonary resistance r = 0.70; all P < .001). In patients with residual pulmonary hypertension after pulmonary endarterectomy, the 6-minute walk distance was significantly lower than in hemodynamically normalized patients. However, the absolute increase in the 6-minute walk distance was higher in patients with residual pulmonary hypertension (137 ± 26 m and 82 ± 20 m, respectively; P = .03). Conclusions The 6-minute walk distance was demonstrated to reflect the clinical and hemodynamic severity of disease in patients with chronic thromboembolic pulmonary hypertension. One year after pulmonary endarterectomy, the 6-minute walk distance had increased significantly, and the change in the 6-minute walk distance correlated with the observed clinical and hemodynamic improvement.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Chronic Disease</subject><subject>Cohort Studies</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Endarterectomy - methods</subject><subject>Endarterectomy - mortality</subject><subject>Exercise Test - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Hypertension, Pulmonary - mortality</subject><subject>Hypertension, Pulmonary - surgery</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Pneumology</subject><subject>Postoperative Complications - diagnosis</subject><subject>Prospective Studies</subject><subject>Pulmonary Circulation - physiology</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Statistics, Nonparametric</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Rate</subject><subject>Thromboembolism - diagnosis</subject><subject>Thromboembolism - mortality</subject><subject>Thromboembolism - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Patency - physiology</subject><subject>Walking</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk1v1DAQjRCIbgu_AAn5ApyyjJ2PdQ5UQhUFpEocChI3y3HGrBcnDnbSsv-BH82ku9JKXDhYY4_fex7Pmyx7wWHNgddvd-vdZO7SWgDUlFmDgEfZikOzyWtZfX-crQCEyCshirPsPKUdAGyAN0-zM74RlawaWGV_bt3vvHfDPCG71_4n61ya9GCQ6cRGHXWPE0YWLLPzYCYXBu1ZmCcTeoLY5W6cfU_puGc4dDpSCs0U-j2zITKzjWFwhk0U-zYgLU_HE2e7H5E4QyLpZ9kTq33C58d4kX27_vD16lN-8-Xj56v3N7mhqqdctgXSDwyKCjotrZSmhQY1SNzYrqmlFm2NJcrSSC0FwWtblVg3tGmstMVF9vqgO8bwa8Y0qd4lg97rAcOcVC2bsmk2NQGLA9DEkFJEq8boeipbcVCLCWqnHkxQiwlLkkwg1suj_Nz22J04x64T4NURoJPR3kZquEsnnKwELx-ef3PAbd2P7b2LqFKvvSdZvjybeFEooSq-KL47IJHaducwqmQcko2dW9xQXXD_KfnyH77xjnyjicA9pl2YIxmfFFdJKFC3y2QtgwU1cClLWfwFYnrN4g</recordid><startdate>20070201</startdate><enddate>20070201</enddate><creator>Reesink, Herre J., MD</creator><creator>van der Plas, Mart N., MSc, RFT</creator><creator>Verhey, Niesje E., RFT</creator><creator>van Steenwijk, Reindert P., MD</creator><creator>Kloek, Jaap J., MD</creator><creator>Bresser, Paul, MD, PhD</creator><general>Mosby, Inc</general><general>AATS/WTSA</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070201</creationdate><title>Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension</title><author>Reesink, Herre J., MD ; van der Plas, Mart N., MSc, RFT ; Verhey, Niesje E., RFT ; van Steenwijk, Reindert P., MD ; Kloek, Jaap J., MD ; Bresser, Paul, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c585t-8b3e172ce250da8f88cb09ea08e7fd968a2b6e4e84c8a828b36f54e69b369f8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Chronic Disease</topic><topic>Cohort Studies</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Endarterectomy - methods</topic><topic>Endarterectomy - mortality</topic><topic>Exercise Test - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Hypertension, Pulmonary - mortality</topic><topic>Hypertension, Pulmonary - surgery</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Pneumology</topic><topic>Postoperative Complications - diagnosis</topic><topic>Prospective Studies</topic><topic>Pulmonary Circulation - physiology</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Statistics, Nonparametric</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Rate</topic><topic>Thromboembolism - diagnosis</topic><topic>Thromboembolism - mortality</topic><topic>Thromboembolism - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Patency - physiology</topic><topic>Walking</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reesink, Herre J., MD</creatorcontrib><creatorcontrib>van der Plas, Mart N., MSc, RFT</creatorcontrib><creatorcontrib>Verhey, Niesje E., RFT</creatorcontrib><creatorcontrib>van Steenwijk, Reindert P., MD</creatorcontrib><creatorcontrib>Kloek, Jaap J., MD</creatorcontrib><creatorcontrib>Bresser, Paul, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reesink, Herre J., MD</au><au>van der Plas, Mart N., MSc, RFT</au><au>Verhey, Niesje E., RFT</au><au>van Steenwijk, Reindert P., MD</au><au>Kloek, Jaap J., MD</au><au>Bresser, Paul, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2007-02-01</date><risdate>2007</risdate><volume>133</volume><issue>2</issue><spage>510</spage><epage>516</epage><pages>510-516</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objectives In chronic thromboembolic pulmonary hypertension, objective data to assess the functional outcome after pulmonary endarterectomy are lacking. We studied the 6-minute walk distance in relation to the clinical and hemodynamic severity of disease, and assessed the effect of pulmonary endarterectomy on the 6-minute walk distance. Methods A total of 50 consecutive patients with chronic thromboembolic pulmonary hypertension were studied. Subsequently, pulmonary endarterectomy was performed in 42 patients, 35 of whom underwent a 6-minute walk distance 1 year after surgery. Results The mean ± standard error of the mean 6-minute walk distance was 391 ± 19 m. The 6-minute walk distance decreased in proportion to New York Heart Association functional class and correlated (all P < .0001) with mean pulmonary artery pressure (r = −0.62), cardiac output (r = 0.76), total pulmonary resistance (r = −0.75), mixed venous oxygen saturation (r = 0.77), and brain natriuretic peptide (r = −0.65). One year after pulmonary endarterectomy, the 6-minute walk distance increased from 417 ± 19 m to 517 ± 16 m ( P < .0001). The change from baseline in 6-minute walk distance correlated with the changes after 1 year in New York Heart Association functional class ( P < .01) and brain natriuretic peptide (r = 0.57, P < .002), and with the observed hemodynamic changes directly after pulmonary endarterectomy (change in mean pulmonary artery pressure: r = 0.52; change in cardiac output: r = 0.70; change in total pulmonary resistance r = 0.70; all P < .001). In patients with residual pulmonary hypertension after pulmonary endarterectomy, the 6-minute walk distance was significantly lower than in hemodynamically normalized patients. However, the absolute increase in the 6-minute walk distance was higher in patients with residual pulmonary hypertension (137 ± 26 m and 82 ± 20 m, respectively; P = .03). Conclusions The 6-minute walk distance was demonstrated to reflect the clinical and hemodynamic severity of disease in patients with chronic thromboembolic pulmonary hypertension. One year after pulmonary endarterectomy, the 6-minute walk distance had increased significantly, and the change in the 6-minute walk distance correlated with the observed clinical and hemodynamic improvement.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>17258590</pmid><doi>10.1016/j.jtcvs.2006.10.020</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cardiothoracic Surgery Chronic Disease Cohort Studies Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Endarterectomy - methods Endarterectomy - mortality Exercise Test - methods Female Follow-Up Studies Humans Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - mortality Hypertension, Pulmonary - surgery Linear Models Male Medical sciences Middle Aged Natriuretic Peptide, Brain - blood Pneumology Postoperative Complications - diagnosis Prospective Studies Pulmonary Circulation - physiology Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Risk Assessment Severity of Illness Index Statistics, Nonparametric Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Rate Thromboembolism - diagnosis Thromboembolism - mortality Thromboembolism - surgery Time Factors Treatment Outcome Vascular Patency - physiology Walking |
| title | Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension |
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