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Oxygen desaturation on the six-minute walk test and mortality in untreated primary pulmonary hypertension

¹ Dept of Internal Medicine, Division of Cardiology, ² Division of Pulmonary and Critical Care Medicine and ³ Centre for Biostatistics, University of Michigan

CORRESPONDENCE: M. Rubenfire, University of Michigan, 24 Frank Lloyd Wright Drive, 48106, Ann Arbor, MI, USA. Fax: 01 7349987456

Keywords: mortality, oximetry, pulmonary hypertension

Received: January 12, 2000
Accepted October 26, 2000

There are no reliable predictors of mortality in primary pulmonary hypertension (PPH). This study assessed whether exercise oxygen desaturation and distance achieved during a six-minute walk are associated with mortality in moderately symptomatic patients with PPH.

Thirty-four patients with PPH underwent a pretreatment six-minute walk test, and an invasive haemodynamic assessment of pulmonary vasodilator reserve, to select the best treatment option (epoprostenol in 27 and nifedipine in 7). Median follow-up was 26 months (12 months for the nonsurvivors was 26%), and median survival, >46 months by Kaplan-Maier estimate.

The mean±sd distance walked was 275±155 m and reduction in arterial oxygen saturation (S_a,O2) at maximal distance (S_a,O2) was 8.4±4.5%. A distance 300 m increased mortality risk by 2.4, and a S_a,O2 of 10 % increased mortality risk by 2.9. Only S_a,O2 at peak distance, S_a,O2 and pulmonary vascular resistance (PVR) were related to mortality. After adjusting for PVR, there remained a 27% increase in risk of death for each per cent decrease in S_a,O2.

The six-minute walk distance and exercise oxygen saturation may be helpful in selecting patients with primary pulmonary hypertension for whom transplant listing is appropriate.