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Prognostic value of cardiopulmonary exercise testing in patients with systemic sclerosis.
BMC Pulmonary Medicine ( IF 2.6 ) Pub Date : 2019-11-29 , DOI: 10.1186/s12890-019-1003-7
Ralf Ewert 1 , Till Ittermann 2 , Dirk Habedank 3 , Matthias Held 4 , Tobias J Lange 5 , Michael Halank 6 , Jörg Winkler 7 , Sven Gläser 8 , Horst Olschewski 9, 10 , Gabor Kovacs 9, 10
Affiliation  

BACKGROUND Systemic sclerosis (SSc) is a severe rheumatic disease of the interstitial tissue, in which heart and lung involvement can lead to disease-specific mortality. Our study tests the hypothesis that in addition to established prognostic factors, cardiopulmonary exercise testing (CPET) parameters, particularly peak oxygen uptake (peakVO2) and ventilation/carbon dioxide (VE/VCO2)-slope, can predict survival in patients with SSc. SUBJECTS AND METHODS We retrospectively assessed 210 patients (80.9% female) in 6 centres over 10 years with pulmonary testing and CPET. Survival was analysed with Cox regression analysis (adjusted for age and gender) by age, comorbidity (Charlson-Index), body weight, body-mass index, extensive interstitial lung disease, pulmonary artery pressure (measured by echocardiography and invasively), and haemodynamic, pulmonary and CPET parameters. RESULTS Five- and ten-year survival of SSc patients was 93.8 and 86.9%, respectively. There was no difference in survival between patients with diffuse (dcSSc) and limited cutaneous manifestation (lcSSc; p = 0.3). Pulmonary and CPET parameters were significantly impaired. Prognosis was worst for patients with pulmonary hypertension (p = 0.007), 6-min walking distance < 413 m (p = 0.003), peakVO2 < 15.6 mL∙kg- 1∙min- 1, and VE/VCO2-slope > 35. Age (hazard ratio HR = 1.23; 95% confidence interval CI: 1.14;1.41), VE/VCO2-slope (HR = 0.9; CI 0.82;0.98), diffusion capacity (Krogh factor, HR = 0.92; CI 0.86;0.98), forced vital capacity (FVC, HR = 0.91; CI 0.86;0.96), and peakVO2 (HR = 0.87; CI 0.81;0.94) were significantly linked to survival in multivariate analyses (Harrell's C = 0.95). This is the first large study with SSc patients that demonstrates the prognostic value of peakVO2 < 15.6 mL∙kg- 1∙min- 1 (< 64.5% of predicted peakVO2) and VE/VCO2-slope > 35.

中文翻译:

心肺运动测试对系统性硬化症患者的预后价值。

背景技术系统性硬化症(SSc)是间质组织的一种严重的风湿病,其中心脏和肺部受累可导致特定疾病的死亡率。我们的研究检验了以下假设:除确定的预后因素外,心肺运动测试(CPET)参数(尤其是峰值摄氧量(peakVO2)和通气/二氧化碳(VE / VCO2)斜率)还可以预测SSc患者的生存率。研究对象和方法我们回顾性评估了10年内在6个中心进行的210例患者(女性占80.9%)的肺部检查和CPET。使用Cox回归分析法(按年龄和性别调整),根据年龄,合并症(查尔森指数),体重,体质指数,广泛的间质性肺疾病,肺动脉压(通过超声心动图和侵入性测量)和血流动力学分析生存率,肺和CPET参数。结果SSc患者的五年和十年生存率分别为93.8%和86.9%。弥漫性(dcSSc)和皮肤表现受限(lcSSc; p = 0.3)的患者的生存率无差异。肺和CPET参数明显受损。对于肺动脉高压(p = 0.007),6分钟步行距离<413 m(p = 0.003),峰值VO2 <15.6 mL∙kg-1∙min-1和VE / VCO2-斜率> 35的患者,预后最差。年龄(危险比HR = 1.23; 95%置信区间CI:1.14; 1.41),VE / VCO2斜率(HR = 0.9; CI 0.82; 0.98),扩散能力(Krogh因子,HR = 0.92; CI 0.86; 0.98)在多变量分析中,强迫肺活量(FVC,HR = 0.91; CI 0.86; 0.96)和峰值VO2(HR = 0.87; CI 0.81; 0.94)与生存率显着相关(Harrell's C = 0.95)。
更新日期:2019-11-29
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