title: [Prognostic value of clinical exercise testing in idiopathic pulmonary fibrosis].
abstract: Current guidelines for referring patients with idiopathic pulmonary fibrosis (IPF) for lung transplantation, based on resting parameters, are insufficient to predict 3-year mortality. The aim of this study was to determine the prognostic value of cardio-pulmonary exercise testing (CPET) in patients with IPF. A multicentre retrospective study of 3-year outcome was made on 63 adult patients with IPF who underwent CPET with blood gas analysis. Demographic data, resting pulmonary function and CPET parameters were collected to perform a univariate survival analysis. To estimate prognosis at 3 years, a multivariate logistic regression analysis by Kaplan-Meier curves and log-rank tests was performed. Forty-four patients (70%) were alive without lung transplant at the end of the 3-year follow-up: 19 patients (30%) were dead (n=14) or transplanted (n=5). Univariate analysis indicated that: at rest lower TLC, FVC, DLCO and PaCO(2), higher alveolo-arterial gradient for oxygen [P(A-a)O(2)] and pH; at ventilatory threshold (VT) higher VE/VO(2) and VE/VCO(2) and at peak exercise higher VE/VO(2) and VE/VCO(2), higher pH and ΔP(A-a)O(2)/ΔVO(2) (mmHg/L), lower VO(2) peak, PaO(2) and VO(2)/FC were associated with a significantly lower survival at 3 years. The multivariate logistic regression analysis showed that CPT (<65%) and VE/VO(2) at VT (>45) were independently associated with a lower survival at 3 years. Restriction and hyperventilation at ventilatory threshold are major prognostic factors in the course of IPF. CPET with blood gas analysis may have a prognostic value in these patients and initial evaluation of these parameters can help to predict disease progression.
authors.affiliation: Clinique des maladies respiratoires, centre de compétence des maladies pulmonaires rares, hôpital Calmette, CHRU, boulevard du Professeur-Leclercq, Lille cedex, France. benoit.wallaert@chru-lille.fr
authors.forename: B
authors.initials: B
authors.lastname: Wallaert
authors.forename: A
authors.initials: A
authors.lastname: Guetta
authors.forename: L
authors.initials: L
authors.lastname: Wemeau-Stervinou
authors.forename: G
authors.initials: G
authors.lastname: Tercé
authors.forename: M
authors.initials: M
authors.lastname: Valette
authors.forename: R
authors.initials: R
authors.lastname: Nevière
authors.forename: B
authors.initials: B
authors.lastname: Aguilaniu
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001784:Blood Gas Analysis / Q000379:methods; D002245:Carbon Dioxide / Q000097:blood*; D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D005602:France; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood*; D011379:Prognosis; D011659:Pulmonary Gas Exchange; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014797:Vital Capacity
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen