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The Prognostic Value of Cardiopulmonary Exercise Testing in Idiopathic Pulmonary Fibrosis

¹ Division of Respiratory Medicine, University of Calgary, Calgary, Canada; ² Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; ³ Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; ⁴ Department of Radiology, Division of Cardiothoracic Radiology, and ⁷ Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan; ⁵ Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; and ⁶ Department of Pathology, Mayo Clinic, Scottsdale, Arizona

Correspondence and requests for reprints should be addressed to Kevin R. Flaherty, M.D., M.S., Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109. E-mail: flaherty{at}umich.edu

Rationale: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive dyspnea, impaired gas exchange, and ultimate mortality.

Objectives: To test the hypothesis that maximal oxygen uptake during cardiopulmonary exercise testing at baseline and with short-term longitudinal measures would predict mortality in patients with idiopathic pulmonary fibrosis.

Methods: Data from 117 patients with IPF and longitudinal cardiopulmonary exercise tests were examined retrospectively. Survival was calculated from the date of the first cardiopulmonary exercise test.

Measurements and Main Results: Patients with baseline maximal oxygen uptake less than 8.3 ml/kg/min had an increased risk of death (n = 8; hazard ratio, 3.24; 95% confidence interval, 1.10–9.56; P = 0.03) after adjusting for age, gender, smoking status, baseline forced vital capacity, and baseline diffusion capacity for carbon monoxide. We were unable to define a unit change in maximal oxygen uptake that predicted survival in our cohort.

Conclusions: We conclude that a threshold maximal oxygen uptake of 8.3 ml/kg/min during cardiopulmonary exercise testing at baseline adds prognostic information for patients with IPF.

Key Words: idiopathic pulmonary fibrosis • exercise test • mortality

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Prognosis in idiopathic pulmonary fibrosis (IPF) is poor. Predicting prognosis by examining exercise performance with the six-minute-walk test has led to conflicting results. What This Study Adds to the Field This study shows that O2max predicts mortality in patients with IPF. Patients with O2max less than 8.3 ml/kg/min at baseline had an increased risk of death.

 

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