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Original Research: PULMONARY ARTERIAL HYPERTENSION |

Characterization of Pulmonary Arterial Hypertension Patients Walking More Than 450 m in 6 Min at Diagnosis

Bruno Degano, MD, PhD; Olivier Sitbon, MD, PhD; Laurent Savale, MD; Gilles Garcia, MD, PhD; Dermot S. O’Callaghan, MD; Xavier Jaïs, MD; Marc Humbert, MD, PhD; Gérald Simonneau, MD
Author and Funding Information

From the Université Paris-Sud, Faculté de Médecine, Kremlin-Bicêtre; AP-HP, Centre National de Référence de l’Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, Clamart; and INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.

Correspondence to: Bruno Degano, MD, PhD, Service de Pneumologie, Hôpital Antoine-Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart, France; e-mail: degano.b@gmail.com


For editorial comment see page 1258

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(6):1297-1303. doi:10.1378/chest.09-2060
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Background:  At diagnosis of pulmonary arterial hypertension (PAH), some patients are considered to have a “near-normal” 6-min walk distance (6MWD) (ie, > 450 m). Because they are generally excluded from randomized controlled trials, little is known about these patients.

Methods:  We analyzed the baseline characteristics and treatment responses of 49 consecutive patients with a 6MWD > 450 m at the time of newly diagnosed PAH. Data from this cohort were then compared with data from hemodynamically matched patients with a 6MWD ≤ 450 m.

Results:  Patients with a 6MWD > 450 m were either in World Health Organization (WHO) functional class (FC) II (n = 23) or III (n = 26) at baseline. Compared with patients in FC II, those in FC III had more severe hemodynamic impairment (ie, a lower cardiac index and higher pulmonary vascular pressures and resistance) but similar 6MWD. At first evaluation after initiation of PAH-specific treatment (3-6 months), FC improved (FC I-II: n = 38; FC III: n = 11, P < .005) and cardiac index increased. However, 6MWD remained unchanged. Compared with matched patients with a 6MWD ≤ 450 m (n = 98), individuals with a 6MWD > 450 m were approximately 9 years younger (P = .0006) and had a lower BMI (P = .0009).

Conclusions:  Anthropometric characteristics such as younger age and lower BMI may explain higher 6MWD in some PAH patients. In the cohort of patients with a 6MWD > 450 m, hemodynamic indices and WHO FC were more sensitive than 6MWD in detecting changes secondary to PAH-specific treatments.

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