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Original Research: IDIOPATHIC PULMONARY FIBROSIS |

Heart Rate Recovery After 6-Min Walk Test Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis

Jeffrey J. Swigris, DO, MS; Jeff Swick; Frederick S. Wamboldt, MD; David Sprunger, BA, MS; Roland du Bois, MD; Aryeh Fischer, MD; Gregory P. Cosgrove, MD, FCCP; Stephen K. Frankel, MD, FCCP; Evans R. Fernandez-Perez, MD; Dolly Kervitsky, BS; Kevin K. Brown, MD, FCCP
Author and Funding Information

Affiliations: From the Interstitial Lung Disease Program and Autoimmune Lung Center (Drs. Swigris, du Bois, Fischer, Cosgrove, Frankel, Fernandez-Perez, and Brown, Mr. Swick, Mr. Sprunger, and Ms. Kervitsky), Division of Psychosocial Medicine (Dr. Wamboldt), National Jewish Medical and Research Center, Denver, CO.

Correspondence to: Jeffrey J. Swigris, DO, MS, Assistant Professor of Medicine, Interstitial Lung Disease Program and Autoimmune Lung Center, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206; e-mail: swigrisj@njc.org


This work was supported by the National Institutes of Health [grant No. NHLBI SCOR HL67671].

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


© 2009 American College of Chest Physicians


Chest. 2009;136(3):841-848. doi:10.1378/chest.09-0211
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Background:  In patients with idiopathic pulmonary fibrosis (IPF), our objectives were to identify predictors of abnormal heart rate recovery (HRR) at 1 min after completion of a 6-min walk test (6MWT) [HRR1] and 2 min after completion of a 6MWT (HRR2), and to determine whether abnormal HRR predicts mortality.

Methods:  From 2003 to 2008, we identified IPF patients who had been evaluated at our center (n = 76) with a pulmonary physiologic examination and the 6MWT. We used logistic regression to identify predictors of abnormal HRR, the product-limit method to compare survival in the sample stratified on HRR, and Cox proportional hazards analysis to estimate the prognostic capability of abnormal HRR.

Results:  Cutoff values were 13 beats for abnormal HRR1 and 22 beats for HRR2. In a multivariable model, predictors of abnormal HRR1 were diffusing capacity of the lung for carbon monoxide (odds ratio [OR], 0.4 per 10% predicted; 95% confidence interval [CI], 0.2 to 0.7; p = 0.003), change in heart rate from baseline to maximum (OR, 0.9; 95% CI, 0.8 to 0.97; p = 0.01), and having a right ventricular systolic pressure > 35 mm Hg as determined by transthoracic echocardiogram (OR, 12.7; 95% CI, 2.0 to 79.7; p = 0.01). Subjects with an abnormal HRR had significantly worse survival than subjects with a normal HRR (for HRR1, p = 0.0007 [log-rank test]; for HRR2, p = 0.03 [log-rank test]); these results held for the subgroup of 30 subjects without resting pulmonary hypertension (HRR1, p = 0.04 [log-rank test]). Among several candidate variables, abnormal HRR1 appeared to be the most potent predictor of mortality (hazard ratio, 5.2; 95% CI, 1.8 to 15.2; p = 0.004).

Conclusion:  Abnormal HRR after 6MWT predicts mortality in IPF patients. Research is needed to confirm these findings prospectively and to examine the mechanisms of HRR in IPF patients.

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