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Vol. 46. Issue 3.
Pages 122-128 (March 2010)
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Vol. 46. Issue 3.
Pages 122-128 (March 2010)
Original Article
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Peak Oxygen Uptake During the Six-minute Walk Test in Diffuse Interstitial Lung Disease and Pulmonary Hypertension
Consumo máximo de oxígeno durante la prueba de marcha de 6 minutos en la enfermedad pulmonar intersticial difusa y en la hipertensión pulmonar
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Isabel Blanco,
Corresponding author
isabeldoctora@yahoo.es

Corresponding author.
, Claudio Villaquirán♦♦, José Luis Valera, María Molina-Molina, Antoni Xaubet, Robert Rodríguez-Roisin, Joan A. Barberà, Josep Roca
Servei de Pneumologia, Hospital Clínic, Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Abstract
Introduction

The six-minute walk test (6MWT) is widely used in evaluating diffuse interstitial lung disease (ILD) and pulmonary hypertension (PH). However, their physiological determining factors have not been well defined.

Objective

To evaluate the physiological changes that occur in ILD and PH during the 6MWT, and compare them with the cardiopulmonary exercise test (CPET).

Material and Methods

Thirteen patients with ILD and 14 with PH were studied using the 6MWT and CPET on an ergometer cycle. The respiratory variables were recorded by means of telemetry during the 6MWT.

Results

Oxygen consumption (VO2), respiratory and heart rate reached a plateau from minute 3 of the 6MWT in both diseases. The VO2 did not differ from the peak value in the CPET (14±2 and 15±2ml/kg/min, respectively, in ILD; 16±6 and 16±6ml/kg/min, in PH). The arterial oxygen saturation decreased in both diseases, although it was more marked in ILD (−12±5%, P<.01). The ventilatory equivalent for CO2 (VE/VCO2) in PH during the 6MWT was strongly associated with functional class (FC) (85±14 in FC III-IV, 44±6 in FC I-II; P<.001).

Conclusions

The 6MWT in ILD and PH behaves like a maximal effort test, with similar VO2 to the CPET, demonstrating a limit in oxygen transport capacity. Monitoring using telemetry during the 6MWT may be useful for the clinical evaluation of patients with ILD or PH.

Keywords:
Cardiopulmonary exercise
Idiopathic pulmonary fibrosis
Oxygen consumption
Pulmonary hypertension
Six-minute walk test
Resumen
Introducción

La prueba de marcha de 6 minutos (PM6M) es ampliamente utilizada en la evaluación de la enfermedad pulmonar intersticial difusa (EPID) y en la hipertensión pulmonar (HP). Sin embargo, sus determinantes fisiológicos no han sido bien caracterizados.

Objetivo

Evaluar los cambios fisiológicos que ocurren durante la PM6M en la EPID y en la HP y compararlos con la prueba de esfuerzo cardiopulmonar (PECP).

Material y métodos

Se estudiaron 13 pacientes con EPID y 14 con HP mediante PM6M y PECP en cicloergómetro. Durante la PM6M se registraron las variables respiratorias mediante telemetría.

Resultados

El consumo de oxígeno (VO2), la ventilación y la frecuencia cardiaca mostraron una meseta desde el minuto 3 de la PM6M en ambas patologías. El valor de VO2 no difirió del valor pico en la PECP (14±2 y 15±2ml/kg/min, respectivamente, en la EPID; 16±6 y 16±6 ml/kg/min, en la HP). En ambas patologías, disminuyó la saturación arterial de oxígeno, aunque más marcadamente en la EPID (−12±5%, p<0,01). En la HP, el equivalente ventilatorio de CO2 (VE/VCO2) durante la PM6M estaba fuertemente relacionado con la clase funcional (CF) (85±14 en CF III-IV, 44±6 en CF I-II; p<0,001).

Conclusiones

En la EPID y en la HP la PM6M se comporta como una prueba de esfuerzo máxima, con valores de VO2 similares a la PECP, poniendo de manifiesto limitación de la capacidad de transporte de oxígeno. La monitorización mediante telemetría durante la PM6M puede ser útil para la evaluación clínica de los pacientes con EPID o con HP.

Palabras clave:
Ejercicio cardiopulmonar
Fibrosis pulmonar idiopática
Consumo de oxígeno
Hipertensión pulmonar
Prueba de marcha de seis minutos
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References
[1.]
J.L. Fleg, I.L. Pina, G.J. Balady, B.R. Chaitman, B. Fletcher, C. Lavie, et al.
Assessment of functional capacity in clinical and research applications: An advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association.
Circulation, 102 (2000), pp. 1591-1597
[2.]
P. Palange, S.A. Ward, K.H. Carlsen, R. Casaburi, C.G. Gallagher, R. Gosselink, et al.
Recommendations on the use of exercise testing in clinical practice.
Eur Respir J, 29 (2007), pp. 185-209
[3.]
S. Miyamoto, N. Nagaya, T. Satoh, S. Kyotani, F. Sakamaki, M. Fujita, et al.
Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing.
Am J Respir Crit Care Med, 161 (2000), pp. 487-492
[4.]
X.G. Sun, J.E. Hansen, R.J. Oudiz, K. Wasserman.
Exercise pathophysiology in patients with primary pulmonary hypertension.
Circulation, 104 (2001), pp. 429-435
[5.]
K.R. Flaherty, A.C. Andrei, S. Murray, C. Fraley, T.V. Colby, W.D. Travis, et al.
Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test.
Am J Respir Crit Care Med, 174 (2006), pp. 803-809
[6.]
D.J. Lederer, S.M. Arcasoy, J.S. Wilt, F. D’Ovidio, J.R. Sonett, S.M. Kawut.
Six-minute-walk distance predicts waiting list survival in idiopathic pulmonary fibrosis.
Am J Respir Crit Care Med, 174 (2006), pp. 659-664
[7.]
A. Xaubet, J. Ancochea, R. Blanquer, C. Montero, F. Morell, B.E. Rodriguez, et al.
Diagnosis and treatment of diffuse interstitial lung diseases.
Arch Bronconeumol, 39 (2003), pp. 580-600
[8.]
N. Galie, H.A. Ghofrani, A. Torbicki, R.J. Barst, L.J. Rubin, D. Badesch, et al.
Sildenafil citrate therapy for pulmonary arterial hypertension.
N Engl J Med, 353 (2005), pp. 2148-2157
[9.]
L.J. Rubin, D.B. Badesch, R.J. Barst, N. Galie, C.M. Black, A. Keogh, et al.
Bosentan therapy for pulmonary arterial hypertension.
N Engl J Med, 346 (2002), pp. 896-903
[10.]
O. Sitbon, M. Humbert, H. Nunes, F. Parent, G. Garcia, P. Herve, et al.
Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival.
J Am Coll Cardiol, 40 (2002), pp. 780-788
[11.]
A.E. Frost, D. Langleben, R. Oudiz, N. Hill, E. Horn, V. McLaughlin, et al.
The 6-min walk test (6MW) as an efficacy endpoint in pulmonary arterial hypertension clinical trials: demonstration of a ceiling effect.
Vascul Pharmacol, 43 (2005), pp. 36-39
[12.]
S. Rich.
The current treatment of pulmonary arterial hypertension: time to redefine success.
Chest, 130 (2006), pp. 1198-1202
[13.]
A.G. Agusti, J. Roca, J. Gea, P.D. Wagner, A. Xaubet, R. Rodriguez-Roisin.
Mechanisms of gas-exchange impairment in idiopathic pulmonary fibrosis.
Am Rev Respir Dis, 143 (1991), pp. 219-225
[14.]
A.O. Harris-Eze, G. Sridhar, R.E. Clemens, T.A. Zintel, C.G. Gallagher, D.D. Marciniuk.
Role of hypoxemia and pulmonary mechanics in exercise limitation in interstitial lung disease.
Am J Respir Crit Care Med, 154 (1996), pp. 994-1001
[15.]
V.N. Lama, K.R. Flaherty, G.B. Toews, T.V. Colby, W.D. Travis, Q. Long, et al.
Prognostic value of desaturation during a 6-minute walk test in idiopathic interstitial pneumonia.
Am J Respir Crit Care Med, 168 (2003), pp. 1084-1090
[16.]
G. Deboeck, G. Niset, J.L. Vachiery, J.J. Moraine, R. Naeije.
Physiological response to the six-minute walk test in pulmonary arterial hypertension.
Eur Respir J, 26 (2005), pp. 667-672
[17.]
A. Casas, J. Vilaro, R. Rabinovich, A. Mayer, J.A. Barberá, R. Rodriguez-Roisin, et al.
Encouraged 6-min walking test indicates maximum sustainable exercise in COPD patients.
Chest, 128 (2005), pp. 55-61
[18.]
T. Troosters, J. Vilaro, R. Rabinovich, A. Casas, J.A. Barbera, R. Rodriguez-Roisin, et al.
Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease.
Eur Respir J, 20 (2002), pp. 564-569
[19.]
American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias.
This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001.
Am J Respir Crit Care Med, 165 (2002), pp. 277-284
[20.]
J. Roca, F. Burgos, J. Sunyer, M. Saez, S. Chinn, J.M. Anto, Group of the European Community Respiratory Health Survey, et al.
References values for forced spirometry.
Eur Respir J, 11 (1998), pp. 1354-1362
[21.]
J. Roca, F. Burgos, J.A. Barberá, J. Sunyer, R. Rodriguez-Roisin, J. Castellsague, et al.
Prediction equations for plethysmographic lung volumes.
Respir Med, 92 (1998), pp. 454-460
[22.]
D. Chemla, V. Castelain, P. Herve, Y. Lecarpentier, S. Brimioulle.
Haemodynamic evaluation of pulmonary hypertension.
Eur Respir J, 20 (2002), pp. 1314-1331
[23.]
ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–7.
[24.]
[Cardiopulmonary exercise tests] Arch Bronconeumol 2001;37:247–8.
[25.]
Rich S. Executive Summary from the World Symposium on Primary Pulmonary Hypertension 1998. Co-sponsored by The World Health Organization. 1998.
[26.]
N.L. Jones, L. Makrides, C. Hitchcock, T. Chypchar, N. McCartney.
Normal standards for an incremental progressive cycle ergometer test.
Am Rev Respir Dis, 131 (1985), pp. 700-708
[27.]
T. Troosters, R. Gosselink, M. Decramer.
Six minute walking distance in healthy elderly subjects.
Eur Respir J, 14 (1999), pp. 270-274
[28.]
J.A. Neder, L.E. Nery, C. Peres, B.J. Whipp.
Reference values for dynamic responses to incremental cycle ergometry in males and females aged 20 to 80.
Am J Respir Crit Care Med, 164 (2001), pp. 1481-1486
[29.]
P. Palange, S. Forte, P. Onorati, F. Manfredi, P. Serra, S. Carlone.
Ventilatory and metabolic adaptations to walking and cycling in patients with COPD.
J Appl Physiol, 88 (2000), pp. 1715-1720
[30.]
K. Wasserman, J.E. Hansen, D.Y. Sue, B.J. Whipp, R. Casaburi.
Principles of exercise testing and interpretation.
USA, (1994),
[31.]
T.S. Hallstrand, L.J. Boitano, W.C. Johnson, C.A. Spada, J.G. Hayes, G. Raghu.
The timed walk test as a measure of severity and survival in idiopathic pulmonary fibrosis.
Eur Respir J, 25 (2005), pp. 96-103
[32.]
D.R. Dantzker, G.E. D’Alonzo.
Pulmonary gas exchange and exercise performance in pulmonary hypertension.
Chest, 88 (1985), pp. 255S-257S
[33.]
M.M. Hoeper, M.W. Pletz, H. Golpon, T. Welte.
Prognostic value of blood gas analyses in patients with idiopathic pulmonary arterial hypertension.
Eur Respir J, 29 (2007), pp. 944-950
[34.]
R.N. Channick, G. Simonneau, O. Sitbon, I.M. Robbins, A. Frost, V.F. Tapson, et al.
Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study.
Lancet, 358 (2001), pp. 1119-1123

Isabel Blanco is the beneficiary of a grant for training researchers from the Spanish Society of Pneumology and Thoracic Surgery (SEPAR, 2006)

Claudio Villaquirán is the beneficiary of a joint grant for research granted by the SEPAR and the Latin-American Chest Association (ALAT, 2005)

Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
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