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Am. J. Respir. Crit. Care Med., Volume 161, Number 2, February 2000, 487-492

Clinical Correlates and Prognostic Significance of Six-minute Walk Test in Patients with Primary Pulmonary Hypertension
Comparison with Cardiopulmonary Exercise Testing

SHOICHI MIYAMOTO, NORITOSHI NAGAYA, TORU SATOH, SHINGO KYOTANI, FUMIO SAKAMAKI, MASATOSHI FUJITA, NORIFUMI NAKANISHI, and KUNIO MIYATAKE

Division of Cardiology, Department of Medicine, National Cardiovascular Center, Osaka; and College of Medical Technology, Kyoto University, Kyoto, Japan

The six-minute walk test is a submaximal exercise test that can be performed even by a patient with heart failure not tolerating maximal exercise testing. To elucidate the clinical significance and prognostic value of the six-minute walk test in patients with primary pulmonary hypertension (PPH), we sought (1) to assess the relation between distance walked during the six-minute walk test and exercise capacity determined by maximal cardiopulmonary exercise testing, and (2) to investigate the prognostic value of the six-minute walk test in comparison with other noninvasive parameters. The six-minute walk test was performed in 43 patients with PPH, together with echocardiography, right heart catheterization, and measurement of plasma epinephrine and norepinephrine. Symptom-limited cardiopulmonary exercise testing was performed in a subsample of patients (n = 27). Distance walked in 6 min was significantly shorter in patients with PPH than in age- and sex-matched healthy subjects (297 ± 188 versus 655 ± 91 m, p < 0.001). The distance significantly decreased in proportion to the severity of New York Heart Association functional class. The distance walked correlated modestly with baseline cardiac output (r = 0.48, p < 0.05) and total pulmonary resistance (r = -0.49, p < 0.05), but not significantly with mean pulmonary arterial pressure. In contrast, the distance walked correlated strongly with peak V O2 (r = 0.70, p < 0.001), oxygen pulse (r = 0.57, p < 0.01), and V E-VCO2 slope (r = -0.66, p < 0.001) determined by cardiopulmonary exercise testing. During a mean follow-up period of 21 ± 16 mo, 12 patients died of cardiopulmonary causes. Among noninvasive parameters including clinical, echocardiographic, and neurohumoral parameters, only the distance walked in 6 min was independently related to mortality in PPH by multivariate analysis. Patients walking < 332 m had a significantly lower survival rate than those walking farther, assessed by Kaplan-Meier survival curves (log-rank test, p < 0.01). These results suggest that the six-minute walk test, a submaximal exercise test, reflects exercise capacity determined by maximal cardiopulmonary exercise testing in patients with PPH, and it is the distance walked in 6 min that has a strong, independent association with mortality. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing.




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O. Sitbon, V. Gressin, R. Speich, P. S. Macdonald, M. Opravil, D. A. Cooper, T. Fourme, M. Humbert, J.-F. Delfraissy, and G. Simonneau
Bosentan for the Treatment of Human Immunodeficiency Virus-associated Pulmonary Arterial Hypertension
Am. J. Respir. Crit. Care Med., December 1, 2004; 170(11): 1212 - 1217.
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 NEJMHome page
M. Humbert, O. Sitbon, and G. Simonneau
Treatment of Pulmonary Arterial Hypertension
N. Engl. J. Med., September 30, 2004; 351(14): 1425 - 1436.
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 ChestHome page
N. Suleman and A. E. Frost
Transition From Epoprostenol and Treprostinil to the Oral Endothelin Receptor Antagonist Bosentan in Patients With Pulmonary Hypertension
Chest, September 1, 2004; 126(3): 808 - 815.
[Abstract] [Full Text] [PDF]

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 Ann Rheum DisHome page
E Hachulla and J G Coghlan
A new era in the management of pulmonary arterial hypertension related to scleroderma: endothelin receptor antagonism
Ann Rheum Dis, September 1, 2004; 63(9): 1009 - 1014.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
H. H. Leuchte, C. Neurohr, R. Baumgartner, M. Holzapfel, W. Giehrl, M. Vogeser, and J. Behr
Brain Natriuretic Peptide and Exercise Capacity in Lung Fibrosis and Pulmonary Hypertension
Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 360 - 365.
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 ChestHome page
R. J. Oudiz, R. J. Schilz, R. J. Barst, N. Galie, S. Rich, L. J. Rubin, and G. Simonneau
Treprostinil, a Prostacyclin Analogue, in Pulmonary Arterial Hypertension Associated With Connective Tissue Disease
Chest, August 1, 2004; 126(2): 420 - 427.
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 ChestHome page
M. McGoon, D. Gutterman, V. Steen, R. Barst, D. C. McCrory, T. A. Fortin, and J. E. Loyd
Screening, Early Detection, and Diagnosis of Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines
Chest, July 1, 2004; 126(1_suppl): 14S - 34S.
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 ChestHome page
V. V. McLaughlin, K. W. Presberg, R. L. Doyle, S. H. Abman, D. C. McCrory, T. Fortin, and G. Ahearn
Prognosis of Pulmonary Arterial Hypertension*: ACCP Evidence-Based Clinical Practice Guidelines
Chest, July 1, 2004; 126(1_suppl): 78S - 92S.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. M. Hoeper, R. J. Oudiz, A. Peacock, V. F. Tapson, S. G. Haworth, A. E. Frost, and A. Torbicki
End points and clinical trial designs in pulmonary arterial hypertension: Clinical and regulatory perspectives
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 48S - 55S.
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 J Am Coll CardiolHome page
W. Klepetko, E. Mayer, J. Sandoval, E. P. Trulock, J.-L. Vachiery, P. Dartevelle, J. Pepke-Zaba, S. W. Jamieson, I. Lang, and P. Corris
Interventional and surgical modalities of treatment for pulmonary arterial hypertension
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 73S - 80S.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
A. Peacock, R. Naeije, N. Galie, and J.T. Reeves
End points in pulmonary arterial hypertension: the way forward
Eur. Respir. J., June 1, 2004; 23(6): 947 - 953.
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 ChestHome page
S. Huez, S. Brimioulle, R. Naeije, and J.-L. Vachiery
Feasibility of Routine Pulmonary Arterial Impedance Measurements in Pulmonary Hypertension
Chest, June 1, 2004; 125(6): 2121 - 2128.
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 Eur Respir JHome page
G. Deboeck, G. Niset, M. Lamotte, J-L. Vachiery, and R. Naeije
Exercise testing in pulmonary arterial hypertension and in chronic heart failure
Eur. Respir. J., May 1, 2004; 23(5): 747 - 751.
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 Am. J. Physiol. Heart Circ. Physiol.Home page
P. Wauthy, A. Pagnamenta, F. Vassalli, R. Naeije, and S. Brimioulle
Right ventricular adaptation to pulmonary hypertension: an interspecies comparison
Am J Physiol Heart Circ Physiol, April 1, 2004; 286(4): H1441 - H1447.
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 NEJMHome page
B. R. Celli, C. G. Cote, J. M. Marin, C. Casanova, M. Montes de Oca, R. A. Mendez, V. Pinto Plata, and H. J. Cabral
The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease
N. Engl. J. Med., March 4, 2004; 350(10): 1005 - 1012.
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 J Am Coll CardiolHome page
H. H. Leuchte, M. Holzapfel, R. A. Baumgartner, I. Ding, C. Neurohr, M. Vogeser, T. Kolbe, M. Schwaiblmair, and J. Behr
Clinical significance of brain natriuretic peptide in primary pulmonary hypertension
J. Am. Coll. Cardiol., March 3, 2004; 43(5): 764 - 770.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
M. R. Wilkins
Selective or Nonselective Endothelin Receptor Blockade in Pulmonary Arterial Hypertension
Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 433 - 434.
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 Am. J. Respir. Crit. Care Med.Home page
R. J. Barst, D. Langleben, A. Frost, E. M. Horn, R. Oudiz, S. Shapiro, V. McLaughlin, N. Hill, V. F. Tapson, I. M. Robbins, et al.
Sitaxsentan Therapy for Pulmonary Arterial Hypertension
Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 441 - 447.
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 CirculationHome page
N. Nagaya, S. Kyotani, M. Uematsu, K. Ueno, H. Oya, N. Nakanishi, M. Shirai, H. Mori, K. Miyatake, and K. Kangawa
Effects of Adrenomedullin Inhalation on Hemodynamics and Exercise Capacity in Patients With Idiopathic Pulmonary Arterial Hypertension
Circulation, January 27, 2004; 109(3): 351 - 356.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
V.M. Pinto-Plata, C. Cote, H. Cabral, J. Taylor, and B.R. Celli
The 6-min walk distance: change over time and value as a predictor of survival in severe COPD
Eur. Respir. J., January 1, 2004; 23(1): 28 - 33.
[Abstract] [Full Text] [PDF]

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 ChestHome page
K. B. Highland, C. Strange, J. Mazur, and K. N. Simpson
Treatment of Pulmonary Arterial Hypertension: A Preliminary Decision Analysis
Chest, December 1, 2003; 124(6): 2087 - 2092.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
A.R. Glanville and M. Estenne
Indications, patient selection and timing of referral for lung transplantation
Eur. Respir. J., November 1, 2003; 22(5): 845 - 852.
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 HeartHome page
R J Allcock, J J O'Sullivan, and P A Corris
Atrial septostomy for pulmonary arterial hypertension
Heart, November 1, 2003; 89(11): 1344 - 1347.
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 DTBHome page
{blacktriangledown}Bosentan for pulmonary arterial hypertension
DTB, September 1, 2003; 41(9): 70 - 72.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
A. Torbicki, M. Kurzyna, P. Kuca, A. Fijalkowska, J. Sikora, M. Florczyk, P. Pruszczyk, J. Burakowski, and L. Wawrzynska
Detectable Serum Cardiac Troponin T as a Marker of Poor Prognosis Among Patients With Chronic Precapillary Pulmonary Hypertension
Circulation, August 19, 2003; 108(7): 844 - 848.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
M.M. Hoeper, N. Taha, A. Bekjarova, R. Gatzke, and E. Spiekerkoetter
Bosentan treatment in patients with primary pulmonary hypertension receiving nonparenteral prostanoids
Eur. Respir. J., August 1, 2003; 22(2): 330 - 334.
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 Am. J. Respir. Crit. Care Med.Home page
F. Sciurba, G. J. Criner, S. M. Lee, Z. Mohsenifar, D. Shade, W. Slivka, and R. A. Wise
Six-Minute Walk Distance in Chronic Obstructive Pulmonary Disease: Reproducibility and Effect of Walking Course Layout and Length
Am. J. Respir. Crit. Care Med., June 1, 2003; 167(11): 1522 - 1527.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
J.A. Barbera, V.I. Peinado, and S. Santos
Pulmonary hypertension in chronic obstructive pulmonary disease
Eur. Respir. J., May 1, 2003; 21(5): 892 - 905.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
N. Galie, A. L. Hinderliter, A. Torbicki, T. Fourme, G. Simonneau, T. Pulido, N. Espinola-Zavaleta, G. Rocchi, A. Manes, R. Frantz, et al.
Effects of the oral endothelin-receptorantagonist bosentan on echocardiographicand doppler measures in patients with pulmonary arterial hypertension
J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1380 - 1386.
[Abstract] [Full Text] [PDF]

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 ChestHome page
R. Budhiraja and P. M. Hassoun
Portopulmonary Hypertension: A Tale of Two Circulations
Chest, February 1, 2003; 123(2): 562 - 576.
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