Six-minute walking test performance is associated with survival in cirrhotic patients

BACKGROUND Patients with cirrhosis are at risk of cirrhotic cardiomyopathy,with resulting cardiac dysfunction and exercise limitations.Six minute walking test(6MWT)assesses functional status and predicts morbidity and mortality in cardiopulmonary diseases.AIM To determine if it associates with mortality by analyzing 6MWT performance in patients with liver cirrhosis.METHODS A cohort of 106 cirrhotic patients was evaluated in the outpatient setting with echocardiogram and 6MWT and follow up for one year to document hepatic decompensation and mortality.The distance in meters was recorded at the end of 6 min(6MWD).RESULTS This cohort had a mean age of 51 years and 56%male;patients were staged as Child A in 21.7%,B 66%and C 12.3%.Walk distance inversely correlated with Child scores,and was significantly reduced as Child stages progresses.Patients who died(10.4%)showed shorter mean 6MWD(P=0.006).Low 6MWD was an independent predictor of mortality(P=0.01).CONCLUSION 6MWT is a noninvasive inexpensive test whose result is related to Child scores and mortality.It is useful to identify patients with liver cirrhosis at high risk of mortality for closer monitoring and potential early intervention.

Reply to"Six-minute walking test performance is associated with survival in cirrhotic patients"to the editor

Use of the six-minute walk test has been proposed as a prognostic marker in liver cirrhosis.In the Letter to the Editor presented here,the authors highlight some important points,which were raised after the article was published in the November issue of the World Journal of Hepatology.

Effects of a Graded Brisk Walking Test with Different Intensity Levels on Elderly Patients with Essential Hypertension:A Prospective Study in Shanghai,China

Background:This study aimed to clarify the effects of a Graded Brisk Walking Test(GBWT)program on blood pressure(BP)control in elderly patients with essential hypertension and to determine its appropriate degree of intensity for elderly people.Methods:In total,421 out of 620 participants were randomly sampled from a community health center in Shanghai,China.Among them,200 and 221 patients were assigned to the intervened and control groups,respectively.They were all treated with the GBWT program for 8 weeks,16 weeks,and 24 weeks.Results:Based on ANOVA,there was no significant time main effect,condition main effect,or time by condition interaction both in heart rate and body mass index indicators(P>0.05).There were significant condition main effects,time by condition interaction,or time main effects in blood pressure(F=21.875,33.457,65.342,respectively;All P<0.05).After the intervention,significant differences in systolic blood pressure(SBP)and diastolic blood pressure(DBP)values were also observed in the two groups(P<0.05);the average values of the baseline and second phases of the intervention group were significantly lower than those of the control group(P<0.05).Significant differences in blood pressure values after the first two phases were also observed when compared with those before the intervention.Similarly,a significant difference in the first phase and second phase was also found between the BP group and intervention group.However,after the third phase(24 weeks,high-intensity exercise),no significant differences existed both in SBP and DBP groups compared with those before the intervention(P=0.07).Conclusion:GBWT is an effective exercise prescription to mitigate the essential hypertension in elderly Chinese patients,and the intensity,walking distance,and target number of steps can be adjusted according to the age of the patients.

Correlation between the Six-Minute Walk Test and Subjective Functional Class in Patients with Heart Failure

Introduction: The Six-Minute Walk Test (6MWT) is an inexpensive method to objectively evaluate physical capacity or limitation and stratify prognosis in patients with Heart Failure (HF). Since the clinical perception of symptoms may be adapted or compromised, regular evaluation from medical interviews often fails to determine functional classification. This study aimed to assess the correlation between New York Heart Association Functional Class (NYHA-FC) and the distance walked in the 6MWT. Methods: We conducted a cross-sectional observational study that included patients with HF with reduced ejection fraction followed up at an outpatient service of a teaching hospital, from August 2018 to April 2019. Patients in NYHA-FC I, II, or III were included. We compared NYHA-FC subjectively obtained during the consultation with the 6MWT performed after medical consultation, and the correlation between these two parameters was assessed. Results: The study included 70 patients with HF, 41 (58.6%) of whom were female. The mean age was 61.2 ± 12.7 years. The most prevalent etiologies were dilated idiopathic cardiomyopathy (35.7%) followed by ischemic cardiomyopathy (25.7%). The mean ejection fraction was 34.1% ± 9.8%. The average distance walked in the 6MWT by NYHA-FC I patients was 437.8 ± 95.8 meters, NYHA-FC II 360.1 ± 96.4, and NYHA-FC III 248.4 ± 98.3. Functional class measured by the 6MWT was different than that estimated by NYHA-FC in 34 patients (48.6%), 23 (32.9%) for a higher functional class and 11 (15.7%) for a lower one (p = 0.07). Pearson’s correlation coefficient between NYHA-FC and the 6MWT was -0.55. Conclusion: There was a moderate correlation between the subjective NYHA-FC and the 6MWT. The 6MWT revealed a different classification from NYHA-FC in almost half of the patients. Among those who presented discrepancies between methods, 6MWT reclassification towards a higher functional class was more common.

An Assessment of Cardiovascular Functional Capacity of a Group of Chronic Heart Failure Patients Using the 6-Minute Walk Test in a Cameroonian Urban Setting

Background: Chronic heart failure is a public health problem worldwide. It has a high mortality rate and is accompanied by a decreased functional capacity and alteration of the quality of life. Objective: This study aimed to assess the cardiovascular functional capacity of a group of patients suffering from heart failure using the 6-minute walk test (6 MWT). Methods: This was a cross-sectional study carried out in the cardiology unit of Douala’s general hospital for 4 months. We included all eligible patients aged 18 years or more who had stable chronic heart failure and gave informed consent. Those who had an acute coronary syndrome (≤1 month), tachycardia (HR ≥ 120 bpm), high blood pressure (SBP ≥ 180 mmHg and/or DBP ≥ 100 mmHg) and reduced mobility due to orthopaedic reasons were excluded. A 6 MWT was done according to the American Thoracic Society guidelines. The 6 MWT result was considered poor for - 450 m and good for >450 m. Results: We recruited a total of 81 patients (61.7% women) with a mean age of 65.9 ± 10.6 years. The most frequent risk factor for heart failure was high blood pressure (77.8%), alcohol consumption(69.1%) and a sedentary lifestyle (53.1%). The left ventricular ejection fraction was mostly preserved (42.0%) or mildly altered (46.9). The 6 MWT results were poor in 55.6% of cases, average in 19.8% of cases and good in only 24.7% of cases. More than half (59.3%) of the participants perceived the effort as being difficult. The cardiovascular functional capacity was significantly associated with age, heart failure stage and physical activity (p Conclusion: Most patients suffering from chronic stable heart failure in the general hospital of Douala have poor cardiovascular functional capacity.

Functional Capacity of Patients with Venous Thromboembolic Disease Six to Twelve Months after Treatment

Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.

Retrospective study of effect of whole-body vibration training on balance and walking function in stroke patients

BACKGROUND Dysfunction in stroke patients has been a problem that we committed to solve and explore.Physical therapy has some effect to regain strength,balance,and coordination.However,it is not a complete cure,so we are trying to find more effective treatments.AIM To observe the effect of whole-body vibration training(WVT)on the recovery of balance and walking function in stroke patients,which could provide us some useful evidence for planning rehabilitation.METHODS The clinical data of 130 stroke participants who underwent conventional rehabilitation treatment in our hospital from January 2019 to August 2020 were retrospectively analyzed.The participants were divided into whole-body vibration training(WVT)group and non-WVT(NWVT)group according to whether they were given WVT.In the WVT group,routine rehabilitation therapy was combined with WVT by the Galileo Med L Plus vibration trainer at a frequency of 20 Hz and a vibration amplitude of 0+ACY-plusmn+ADs-5.2 mm,and in the NWVT group,routine rehabilitation therapy only was provided.The treatment course of the two groups was 4 wk.Before and after treatment,the Berg balance scale(BBS),3 m timed up-and-go test(TUGT),the maximum walking speed test(MWS),and upper limb functional reaching(FR)test were performed.RESULTS After 4 wk training,in both groups,the BBS score and the FR distance respectively increased to a certain amount(WVT=46.08±3.41 vs NWVT=40.22±3.75;WVT=20.48±2.23 vs NWVT=16.60±2.82),with P<0.05.Furthermore,in the WVT group,both BBS score and FR distance(BBS:18.32±2.18;FR:10.00±0.92)increased more than that in the NWVT group(BBS:13.29±1.66;FR:6.16±0.95),with P<0.05.Meanwhile,in both groups,the TUGT and the MWS were improved after training(WVT=32.64±3.81 vs NWVT=39.56±3.68;WVT=12.73±2.26 vs NWVT=15.04±2.27,respectively),with P<0.05.The change in the WVT group(TUGT:17.49±1.88;MWS:6.79±0.81)was greater than that in the NWVT group(TUGT:10.76±1.42;MWS:4.84±0.58),with P<0.05.CONCLUSION The WVT could effectively improve the balance and walking function in stroke patients,which may be good for improving their quality of life.

Application of Six-minute Walk Test in Heart Transplantation Patients

Objectives To analyze the six-minute walk test （6MWT） and gas exchange of 5 heart transplantation patients and to approach the variation tendency of exercise tolerance, oxygen uptake （ VO2 ） and heart rate chronotropic response. Methods 5 cases of heart transplantation patients （ age 25 - 52 years） were undertaken 6MWT 6 - 30 months after operation, synchronizing gas exchanging parameters were measured by wireless portable remote sensing K4B^2 gas analyzer, 51 normal controls were compared. Results The six-minute walk distance （6MWD） of 5 patients were （592.6 ± 26.7 ） m （558 - 625 ） m, the ascending tendency during exercise was slower, the maximum heart rates were 80% ± 6% of age-predicting maximal heart rate, lower than normal control （86%） ; the end point VO2/kg were （21.8 ± 1.4 ） mL/min · kg （ 19. 94 - 23.60） mL/min · kg. Conclusions The 6WMD and VO2 of 5 patients reached normal range, but the heart rate chronotropic response and VO2 ascending tendency were slower than those of normal controls.

A Study of Real-time Peak Oxygen Consumption and Six-minute Walk Test

Objectives To assess the relationship between peak oxygen consumption （PVO2） and the ambulation distance in six-minute walk test （6MWT）among the healthy subjects. Methods The 51 healthy subjects were recruited for the six-minute walk test. Data of pulmonary gas exchange breath by breath, such as VO2 , VCO2 were real-time measured with wireless remote sensing K4B2, so to study the relationship between peak oxygen uptake and the ambulation distance. Results It was noticed that there was a positive linear correlation between the ambulation distance and PVO2 （ r =0. 619, P 〈0. 001 ） in six-minute walk test. The regression equation was set up （ VO2/kg =0. 05D -6. 331, P 〈 0. 001 ）. PVO2 〉 PVCO2 ,R 〈 1 were found,which suggested that 6MWT was a test below anaerobic threshold. Conclusions There was a closely positive linear correlation between the ambulation distance and PVO2, which is safety, convenient and valuable for the evaluation of cardiopulmonary function and the treatment of cardiopulmonary rehabilitation.

The Impact of Footwear on Posture, Gait and Balance

Background: The objective of this study was to investigate the effects of footwear on posture and balance while walking. The types of footwear investigated in this study were open back shoes, commonly worn by hospitalized patients, and closed back shoes. Previous studies have shown that open back shoes, or slippers, increase the risk of falling (among elderly). We hypothesized that our findings would suggest that open back shoes negatively affect gait mechanics in healthy individuals. Methods: Healthy individuals (n = 12) participated in a walking test while wearing closed back shoes and open back shoes. The explanatory variables in this study were the analysis of gait, posture, and balance before and after walking. The objective variable was footwear (closed back shoes vs. open back shoes). A paired t-test was performed to detect significant differences between the two conditions. Results: Among the test items measured, we found a significant difference in minimum wide tilt angle and left-right differences in step length and intensity while walking between the conditions of closed back shoes and open back shoes. These results suggest that open back shoes could negatively impact posture and balance while walking, even in healthy subjects. Conclusion: It is imperative to improve patient awareness of the risk of falling. We believe that the inclusion of our findings in educational pamphlets and in-house notices could help improve patient awareness and more effectively prevent falls among patients.

Effects of an active lifestyle on the physical frailty of liver transplant candidates

BACKGROUND Liver transplantation is the most important therapeutic intervention for end-stage liver disease(ELD).The prioritization of these patients is based on the model for end-stage liver disease(MELD),which can successfully predict short-term mortality.However,despite its great validity and value,it cannot fully incorporate several comorbidities of liver disease,such as sarcopenia and physical frailty,variables that can sufficiently influence the survival of such patients.Subsequently,there is growing interest in the importance of physical frailty in regard to mortality in liver transplant candidates and recipients,as well as its role in improving their survival rates.AIM To evaluate the effects of an active lifestyle on physical frailty on liver transplant candidates.METHODS An observational study was performed within the facilities of the Department of Transplant Surgery of Aristotle University of Thessaloniki.Twenty liver transplant candidate patients from the waiting list of the department were included in the study.Patients that were bedridden,had recent cardiovascular incidents,or had required inpatient treatment for more than 5 d in the last 6 mo were excluded from the study.The following variables were evaluated:Activity level via the International Physical Activity Questionnaire(IPAQ);functional capacity via the 6-min walking test(6MWT)and cardiopulmonary exercise testing;and physical frailty via the Liver Frailty Index(LFI).RESULTS According to their responses in the IPAQ,patients were divided into the following two groups based on their activity level:Active group(A,10 patients);and sedentary group(S,10 patients).Comparing mean values of the recorded variables showed the following results:MELD(A:12.05±5.63 vs S:13.99±3.60;P>0.05);peak oxygen uptake(A:29.78±6.07 mL/kg/min vs S:18.11±3.39 mL/kg/min;P<0.001);anaerobic threshold(A:16.71±2.17 mL/kg/min vs S:13.96±1.45 mL/kg/min;P<0.01);6MWT(A:458.2±57.5 m vs S:324.7±55.8 m;P<0.001);and LFI(A:3.75±0.31 vs S:4.42±0.32;P<0.001).CONCLUSION An active lifestyle can be associated with better musculoskeletal and functional capacity,while simultaneously preventing the evolution of physical frailty in liver transplant candidates.This effect appears to be independent of the liver disease severity.

Normative Values of Cardio-Respiratory Endurance in Adults in Benin

Cardiorespiratory endurance is a determining factor in the assessment of the state of health of a person. Objective: To determine the reference values for cardiorespiratory endurance in Beninese adults. Methods: Prospective transversal study, with a descriptive and analytical aim. It was carried out on healthy adult subjects (18 to 50 years old), of Cotonou and Abomey cities, from October 2017 to May 2018, without clinically identifiable orthopedic, cardiorespiratory, osteoarticular or neuromotor impairment. These subjects performed three different cardio-respiratory endurance tests: The six-minute walk test (WT6), cycloergometer test (CT) and the step test (ST). Data processing and analysis were done using SPSS version 22 software. A linear regression model was used to establish the prediction equation of maximal oxygen uptake (VO2 max) with the WT6 data. The significance level chosen was 5%. Results: Subjects average age was 30.0 ± 9.8 years. It was especially men (54.20%), students (42.13%), with a normal corpulence (69.91%). At WT6, they walked 365 m to 798 m (557.1 ± 93.6 m) with extreme heart rates (EHR) of 67 to 189 (136.7 ± 19.0) beats per minute. At ST, the extreme powers developed were 2.7 watts/kg and 11.8 watts/kg (6.4 ± 1.8 watts/kg), with EHR of 99 to 204 (168.4 ± 15.4) beats per minute. The predictor equation of VO2 max by WT6 was function of the subject’s weight, age and sex (R = 0.73). Conclusion- Discussion: These normative values of cardio-respiratory endurance of Beninese subjects seem to be specific to them. An extension of the present study to a larger sample nevertheless seems desirable.

冠状动脉介入治疗对急性心肌梗死患者心功能的影响

目的探究冠状动脉介入治疗对急性心肌梗死患者心功能的影响。方法选取2020年7月-2023年6月我院收治的86例急性心肌梗死患者,根据不同治疗方式分成对照组和观察组,每组各43例。对照组接受常规治疗,观察组接受冠状动脉介入,对比两组治疗前后心功能指标[左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)、左心室射血分数(LVEF)]、6 min步行试验(6-minute walk test,6MWT)以及心脏不良事件发生率。结果治疗前,两组心功能标对比(P>0.05),治疗4周后,观察组LVEDVI、LVESVI下降较对照组明显,LVEF提升较对照组明显,具有显著差异(P<0.05);治疗1周后,两组6MWT对比无统计学意义(P>0.05),治疗2周、治疗4周后,两组6MWT逐渐提升,观察组较对照组提升明显,具有统计学意义(P<0.05);两组心脏不良事件发生率对比,观察组更低(P<0.05)。结论急性心肌梗死患者行冠状动脉介入治疗,能改善患者心功能,提高患者6MWT距,改善运动耐力,对于心脏不良事件发生率的降低有积极作用。

Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities

Background The relationship between the 6-minute walk test （6MWT） and pulmonary function test in stable chronic obstructive pulmonary disease （COPD） remains unclear. We evaluate the correlation of 6MWT and spirometric parameters in stable COPD with different severities. 6MWT data assessed included three variables： the 6-minute walk distance （6MWD）, 6-minute walk work （6MWORK）, and pulse oxygen desaturation rate （SPO2%）. Methods 6MWT and pulmonary function test were assessed for 150 stable COPD patients with different severities. Means and standard deviations were calculated for the variables of interest. Analysis of variance was performed to compare means. Correlation coefficients were calculated for 6MWT data with the spirometric parameters and dyspnea Borg scale. Multiple stepwise regression analysis was used to screen pulmonary function-related predictors of 6MWT data. Results The three variables of 6MWT all varied as the severities of the disease. The 6MWD and 6MWORK both correlated with some spirometric parameters （positive or negative correlation; the absolute value of r ranging from 0.34 to 0.67; P 〈0.05） in severe and very severe patients, and the SPO2% correlated with the dyspnea Borg scale in four severities （t= -0.33, -0.34, -0.39, -0.53 respectively; P 〈0.05）. The 6MWD was correlated with the 6MWORK in four severities （r=0.56, 0.57, 0.72, 0.81 respectively, P 〈0.05）, and neither of them correlated with the SPO2%. The percent of predicted forced expiratory volume in 1 second （FEV1% predicted） and residual volume to total lung capacity ratio （RV/TLC） were predictors of the 6MWD, and the maximum voluntary ventilation （MW） was the predictor of the 6MWORK. Conclusions 6MWT correlated with the spirometric parameters in severe and very severe COPD patients. 6MWT may be used to monitor changes of pulmonary function in these patients.

Nine-hole Peg Test and Ten-meter Walk Test for Evaluating Functional Loss in Chinese Charcot-Marie-Tooth Disease

Background：The 9-hole peg test （9-HPT） and 10-meter walk test （10-MWT） are commonly used to test finger motor function and walking ability.The aim of this present study was to investigate the efficacy of these tests for evaluating functional loss in Chinese Charcot-Marie-Tooth （CMT） disease.Methods：Thirty-four Chinese CMT patients （CMT group） from August 2015 to December 2016 were evaluated with 9-HPT,10-MWT,CMT disease examination score,overall neuropathy limitation scale （ONLS）,functional disability score,and Berg Balance Scale （BBS）.Thirty-five age-and gender-matched healthy controls （control group） were also included in the study.Student＇s nonpaired or paired t-test were performed to compare data between two independent or related groups,respectively.The Pearson test was used to examine the correlations between recorded parameters.Results：The mean 9-HPT completion time in the dominant hand of CMT patients was significantly slower than that in the healthy controls （29.60 ± 11.89 s vs.19.58 ± 3.45 s;t =-4.728,P 〈 0.001）.Women with CMT completed the 9-HPT significantly faster than men with CMT （dominant hand：24.74 ± 7.93 s vs.33.01 ± 13.14 s,t =2.097,P =0.044）.The gait speed of the average self-selected velocity and the average fast-velocity assessed using 10-MWT for CMT patients were significantly slower than those in the control group （1.03 ± 0.18 m/s vs.1.44 ± 0.17 m/s,t =9.333,P 〈 0.001;1.31 ± 0.30 m/s vs.1.91 ± 0.25 m/s,t =8.853,P 〈 0.00 1,respectively）.There was no difference in gait speed between men and women.Both 9-HPT and 10-MWT were significantly correlated with the ONLS,functional disability score,and BBS （P 〈 0.05 for all）.Conclusion：The 9-HPT and 10-MWT might be useful for functional assessment in Chinese patients with CMT.

Effects of Feiwei granules in the treatment of idiopathic pulmonary fibrosis:a randomized and placebo-controlled trial

OBJECTIVE:To document the therapeutic effect of Feiwei granules(FGs) for idiopathic pulmonary fi brosis(IPF).METHODS:One hundred cases with IPF were randomized into the treatment group(80) and control group(20).Both groups were given basic treatment with prednisone.The treatment group was given FGs,and the control group was given Jinshuibao capsules(JCs).Treatment lasted for 6 months.The Medical Research Council Dyspnea Scale(MRCDS),the Saint George's Hospital Respiratory Questionnaire(SGHRQ),pulmonary function,the Traditional Chinese Medicine Syndrome Score(TCMSS),6-min walking test(6MWT) and blood gas analyses were recorded before the study as well as3 months and 6 months after treatment.RESULTS:FGs showed greater efficacy than the control in certain parameters between before the study and 6 months,and between 3 months and 6months,in the MRCDS,some indicators in the SGHRQ,and the TCMSS.There were no significant differences between the treatment group and control group in the remainder of the indices evaluated.In the treatment group,there were significant differences in before and after treatment in the MRCDS,SGHRQ,TCMSS and 6MWT.CONCLUSION:FGs were similar to JCs for IPF treatment.

Effects of Qizhukangxian granules on idiopathic pulmonary fibrosis:a randomized,double blind,placebo-controlled and multicenter clinical pilot trial

OBJECTIVE:To evaluate the effects of Qizhukangxian granules(QG)on idiopathic pulmonary fibrosis(IPF).METHODS:This is a randomized,double blind,placebo-controlled and multicenter clinical pilot trial.Six medical centers in Tianjin,China,participated in the study.A total of 120 IPF patients were enrolled and randomized into two groups,with 60 patients in each group.The treatment group was treated with QG,while the control group received a Qizhukangxian placebo.The pharmacological treatment lasted for 48 weeks from the enrollment date.The indexes of patients were recorded on the admission day and at the end of the 24th and 48th weeks.Data were analyzed to study the effects of QG;forced vital capacity,change in forced vital capacity and maximal 6-min walk test(6MWT)distance were the primary endpoints.Secondary endpoints were percentage of patients with episodes of acute exacerbation of IPF,pulmonary function,changes in pulse oxygen saturation during the 6MWT,dyspnea score,St.George's respiratory questionnaire score,arterial blood gas analyses and the total Traditional Chinese Medicine symptom pattern score.RESULTS:After 24 weeks of treatment,QG showed greater efficacy than the placebo in certain parameters,including the dyspnea score,Traditional Chinese Medicine symptom pattern score and some indicators in the St.George's respiratory questionnaire score.Analysis of the indexes obtained from all patients at the end of the 48th week showed that the therapeutic effects in the treatment group were significantly better than those in the control group because remarkable differences were observed in most of the primary and secondary endpoints between the two groups,except for the maximal distance of the 6MWT and arterial blood gas analyses.No adverse reaction was observed in either group during the 48-week trial treatment period.CONCLUSION:QG could effectively treat IPF patients by ameliorating pulmonary function,improving the quality of life and lowering the percentage of acute exacerbations.

Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure（s SVCP）, mean superior vena cava pressure（m SVCP）, and left pulmonary artery systolic pressure（s LPAP） were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg（P = 0.025）,s RPAP ≤ 22 mm Hg（P = 0.0001, mRPAP ≤ 13 mm Hg（P =0.003）, s LPAP ≤ 27 mm Hg（P =0.03）, m LPAP ≤ 11 mm Hg（P = 0.01）, PVR ≤ 4.3 Wood U/m^2（P 〈0.0001） and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg（P = 0.06） and s PVR ≤ 2.0 wood U/m^2（P = 0.0531）. One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m^2 can help identify post Glenn-shunt patients indicated for TCPC.