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Does arterial oxygenation during exercise add prognostic value in pulmonary arterial hypertension?

  • Xavier Alsina-Restoy
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
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  • Rodrigo Torres-Castro
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain

    Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
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  • Yolanda Torralba-García
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain

    CIBER Enfermedades Respiratorias (CIBERES), Spain
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  • Felip Burgos
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain

    University of Barcelona, Spain
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  • Joan Albert Barberà
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain

    CIBER Enfermedades Respiratorias (CIBERES), Spain

    University of Barcelona, Spain
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  • Àlvar Agustí
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain

    CIBER Enfermedades Respiratorias (CIBERES), Spain

    University of Barcelona, Spain
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  • Isabel Blanco
    Correspondence
    Corresponding author. Servei Pneumologia, Hospital Clínic Barcelona. Villarroel 170, 08036, Barcelona, Spain.
    Affiliations
    Pulmonary Medicine Department, Respiratory Institute, Hospital Clinic Barcelona, Spain

    Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain

    CIBER Enfermedades Respiratorias (CIBERES), Spain

    University of Barcelona, Spain
    Search for articles by this author
Published:December 03, 2022DOI:https://doi.org/10.1016/j.rmed.2022.107070

      Highlights

      • Several composite indices can integrate 6MWD and arterial oxygenation changes.
      • These composite indexes predict mortality in some chronic respiratory diseases.
      • Arterial oxygenation during exercise does not add prognostic value to that of the 6MWD in PAH.

      Abstract

      Background

      The 6-min walking distance (6MWD) is often used to assess prognosis in pulmonary arterial hypertension (PAH) patients. Whether or not changes in arterial oxygen saturation (SpO2) during exercise add prognostic value to the 6MWD in these patients is unclear. The objective of this study was to investigate if SpO2 changes during exercise adds prognostic value to the 6MWD in PAH patients.

      Methods

      Ambispective study that includes 137 patients with PAH: 38 idiopathic/heritable (i/h PAH), 42 with connective tissue disease (CTD-PAH), 34 with porto-pulmonary hypertension (PoPH), 21 with HIV-associated PAH and 2 with pulmonary venous occlusive disease (PVOD). Patients were characterized and, treated according to international recommendations, and were followed-up for 5 years. To integrate SpO2 changes during exercise, we calculated the desaturation distance ratio (DDR) either in its original form (from a maximal theoretical value of 100%) or the actual resting SpO2 value of the patient (new DDR) as well as the distance saturation product (DSP).

      Results

      (1) during follow-up, 40 patients died (29.2%); (2) results confirmed the prognostic value of the 6MWD (AUC 0.913 [IQR 0.868–0.958]; p < 0.0001), original DDR (AUC 0.923 [0.881–0.966]; p < 0.001), New DDR (AUC 0.917 [0.872–0.961], p < 0.001), and DSP (AUC 0.914 [0.869–0.959], p < 0.001); and, (3) neither the original or new DDR or DSP added significant prognostic value to 6MWD in these patients.

      Conclusions

      Consideration of three different composite indices of arterial oxygenation changes during exercise does not add prognostic value to that of the 6MWD in patients with PAH.

      Keywords

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