TY - JOUR T1 - Predictive value of 6 MWD and derived indices 3 months after initial PAH therapy for the necessity of a combination therapy in patients with pulmonary arterial hypertension JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P4058 AU - David Korte AU - Andreas Rolf AU - Werner Seeger AU - Ardeschir Ghofrani AU - Robert Voswinckel Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P4058.abstract N2 - Aims and objectives6MWD based prediction of the necessity of future therapy escalation in pulmonary arterial hypertension.MethodsWe retrospectively analyzed 145 PAH patients. Parameters were assessed at initial presentation and 3 months after initiation of PAH monotherapy, time until extension of therapy was documented.Parameters:6MWD, Borg scale, 6MWD reference equations (RE; Troosters, Enright, Gibbons), percentage of 6MWD related to RE. We introduced an index containing Borg results related to RE (Index = (CR10 + 1) / a6MWD; CR10: Borg CR10 value, a6MWD: ratio of 6MWD related to RE's).ResultsAmong all parameters, the BORG incorporating index based on Enright’s RE showed largest AUC (0.6031). Youden index optimal cut-off was 5.74 (68% sensitivity, 57% specificity). Mean therapy escalation free survival was 1767 days (1412 – 2122 95% CI) for patients below the cut-off and 906 days (706 – 1105 95% CI) for patients above the cut-off (p = 0.0001). Univariate Cox proportional hazards model showed that the likelihood of therapy escalation more than doubles, if the patient has an index above the cut-off (hazard ratio 2.3 (1.4 - 3.78 95% CI, p=0.001)). The 6MWD as single parameter showed a sensitivity and specifity of 37% and 80% respectively, AUC of 0.582, hazard ratio 2.0 (1.25 - 3.28 95% CI, p=0.004).ConclusionsOur newly introduced 6MWD index, generated 3 months after PAH thearpy initiation, had the highest prognostic relevance to predict therapy escalation in PAH. ER -