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Diffuse Lung Disease |

Heart Rate Recovery as a Predictor of Clinical Worsening in Patients With Pulmonary Arterial Hypertension Associated With Connective Tissue Diseases

Quyen Nguyen*, MD; Srinivas Mummadi, MD; Ravi Gudavalli, MD; Kevin McCarthy, RPSGT; Omar Minai, MD
Author and Funding Information

Deparment of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH


Chest. 2012;142(4_MeetingAbstracts):432A. doi:10.1378/chest.1389598
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Abstract

SESSION TYPE: Interesting Topics in ILD

PRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM - 04:15 PM

PURPOSE: We aimed to evaluate the association between heart rate recovery at one minute of rest (HRR1) after the 6-minute walk (6MW) test and clinical worsening in patients with pulmonary hypertension (PH) associated with connective tissue diseases (CTD).

METHODS: Patients with pulmonary hypertension and a diagnosis of systemic sclerosis (SSc) or systemic lupus erythematosus (SLE) who underwent the 6MW test between August 1, 2009 and December 30, 2011 were included in the analysis.

RESULTS: 80 patients who were diagnosed with PH associated with CTD completed the 6MW test. Compared to patients with SLE [N=13 (16.3%)], patients with SSc [N=67 (83.7%)] were older (60 +/- 14 vs. 51 +/- 13 years; p = 0.01), more likely to be Caucasian (79% vs. 38%; p=0.005), and had lower BMI (28 +/- 6 vs. 34 +/- 9 kg/m2; p<0.001). Patients with with SSc and SLE did not significantly differ in baseline pulmonary function test variables (% predicted FVC, FEV1, and DLCO) and 6MW test variables (6MW distance, baseline heart rate, peak heart rate, and HRR1). Patients with HRR1 < 16 had lower % predicted DLCO (36 +/- 17 vs 53 +/- 27; p = 0.002) and lower 6MW distance (280 + 90 vs 363 + 105; p < 001) compared to those with HRR1 >/= 16. In contrast to patients with HRR1 >/= 16, those with HRR1 < 16 were more likely to have a clinical worsening event (hospitalization, lung, transplant, or death) (OR 4.9; 95% CI [1.28, 18.9]; p = 0.021), and shorter time to first clinical worsening during follow up (146 +/- 138 vs 467 +/- 303 days; p < 0.001).

CONCLUSIONS: In patients with PH associated with CTD, reduced HRR1 after the 6MW test is a predictor of clinical worsening.

CLINICAL IMPLICATIONS: HRR1 after 6MW test is a non-invasive and easily obtained measurement that can potentially aid in predicting clinical outcome in patients with PH associated with CTD.

DISCLOSURE: Omar Minai: Fiduciary position (of any organization, association, society, etc, other than ACCP: Member of SAB and Speakers Bureau for Actelion, Gilead, United Therapeutics, and Pfizer, Fiduciary position (of any organization, association, society, etc, other than ACCP: Member of SAB for Bayer

The following authors have nothing to disclose: Quyen Nguyen, Srinivas Mummadi, Ravi Gudavalli, Kevin McCarthy

No Product/Research Disclosure Information

Deparment of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH

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