Prediction of Future Overt Pulmonary Hypertension by 6-Min Walk Stress Echocardiography in XXXX With Connective Tissue Disease.

@entity1 @entity2597 @entity120 @entity7215
BACKGROUND: Early detection of @entity120 ( @entity120 ) in @entity2597 ( @entity2597 ) is crucial to ensuring that @entity1 receive timely treatment for this progressive disease. Exercise stress tests have been used to screen @entity1 in an attempt to identify early-stage @entity120 . Recent studies have described abnormal mean pulmonary artery pressure ( @entity7215 )-cardiac output (Q) responses as having the potential to assess the disease state. OBJECTIVES: This study hypothesized that pulmonary circulation pressure-flow relationships obtained by 6-min walk (6MW) stress echocardiography would better delineate differential progression of @entity120 and predict development of @entity120 during follow-up. METHODS: We prospectively performed 6MW stress echocardiographic studies in 78 @entity2597 @entity1 (age 58    12 years; 9% male) at baseline and follow-up. All @entity1 underwent yearly echocardiographic follow-up studies for up to 5 years. RESULTS: During a median period of 32 months (range: 15 to 62 months), 16 @entity1 reached the clinical endpoint of development of @entity120 and none died during follow-up. @entity120 was confirmed by right heart catheterization in all 16 @entity1 ( @entity7215  >= 25 mm  Hg and pulmonary capillary wedge pressure   <=15 mm  Hg). In a Cox proportional-hazards survival model, 6MW distance (hazard ratio [HR]: 0.99; p  = 0.010), early diastolic tricuspid annulus motion velocity (HR: 0.79; p  =  0.025), and   @entity7215 /  Q by 6MW stress (HR: 1.10; p  = 0.005) were associated with development of @entity120 . In sequential Cox models, a model on the basis of 6MW distance (chi-square, 6.6) was improved by   @entity7215 /  Q (chi-square: 14.4; p  =  0.019). Using a receiver-operating characteristic curve, we found that the best cutoff value of   @entity7215 /  Q for predicting development of @entity120 was >3.3 mm  Hg/l/min. CONCLUSIONS: The 6MW stress echocardiography noninvasively provides an incremental prognostic value of @entity120 development in @entity2597 . This is a single-center prospective cohort study. Larger multicenter studies are warranted to confirm this result.
