Published: 2018-03-21

Correlation of grade of pulmonary artery pressure with six minutes walk distance and dyspnoea grading in group 3 pulmonary artery hypertension

Aruna Shanmuganathan, Advita G., Meenakshi N., Ragulan R., Nisha Ganga, Pukazhenthi K.


Background: Pulmonary Artery Hypertension (PAH) is defined as mean pulmonary artery pressure greater than 25 mmHg at rest as assessed by Right heart catheterization. 1 PAH secondary to lung disease is categorized under Group 3 PAH according to WHO classification, the major causes being COPD, ILD, OSA etc. Only few studies have analyzed the clinico-radiological profile, severity, morbidity and mortality associated with group 3 PAH. Hence this study was undertaken to study the clinic-radiological and functional profile of patients with group 3 pulmonary hypertension and to correlate grade of PAH with six-minute walk distance (6MWD) and Dyspnoea grading by modified Medical Research Council (mMRC). Primary objective was to correlate grade of PAH with 6MWD and dyspnoea grading (mMRC) in group 3 pulmonary artery hypertension. Secondary objective was to study the clinic- radiological and functional profile of patients with group 3 pulmonary hypertension in a tertiary care centre.

Methods: Seventy two patients diagnosed to have PAH by 2D ECHO with underlying lung disease were retrospectively analyzed in Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai. Their demographic data, clinical history, examination, Dyspnoea according to MMRC grading, Chest X ray, CT chest, ECG, 2D ECHO (using VIVID 5), PFT (Easy on PC 2700-1-01. EOPC SN 219295, ATS guidelines), six minute walk test (ATS guidelines) and other Special investigations like CT Pulmonary Angiogram, Polysomnography were included wherever necessary.

Results: Out of the 72 patients with group 3 PAH 44.4% belong to the age group of 46-65 years with a mean age of 57.59±13.6 years along with a slight male preponderance. The commonest cause being COPD (27.7%) followed by ILD (15.30%) and Bronchiectasis (5.50%) and the combined etiology contributing to 48.8%. There was a statistically significant positive correlation between grade of PAH and mMRC score (p< 0.05) and significant negative correlation between grade of PAH with 6MWD and FEV1 (p <0.05).

Conclusions: This study shows that Simple bed side tools like 6MWD and mMRC score can be used for the evaluation of presence and severity of Group 3 PAH.


3 PAH, FEV1, mMRC score, Six Minute walk distance (6MWD)

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Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Frantz R, Khanna D, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D42-50.

Simonneau G, Gatzoulis MA, Adatia I, Celemajer D, Denton C, Ghofrani A, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25):D34-D41.

Klinger JR. Group III pulmonary hypertension: pulmonary hypertension associated with lung disease: epidemiology, pathophysiology, and treatments. Cardiol Clin. 2016;34(3):413-33.

Behr J, Ryu JH. Pulmonary hypertension in interstitial lung disease. Eur Respir J. 2008;31(6):1357-67

Kholdani C, Fares WH, Mohsenin V. Pulmonary hypertension in obstructive sleep apnea: is it clinically significant? A critical analysis of the association and pathophysiology. Pulmonary circulation. 2015;5(2):220-7.

Dumitrescu D, Sitbon O, Weatherald J, Howard LS. Exertional dyspnoea in pulmonary arterial hypertension. Eur Respir Rev. 2017;26(145).

Elwing J, Panos RJ. Pulmonary hypertension associated with COPD. Int J Chron Obstrct Pulmon Dis. 2008;3(1):55-70.

Demir R, Küçükoğlu MS. Six-minute walk test in pulmonary arterial hypertension. Anatolian J Cardiol. 2015;15(3):249.

Jing ZC, Xu XQ, Badesch DB, Jiang X, Wu Y, Liu JM, et al. Pulmonary function testing in patients with pulmonary arterial hypertension. Respiratory Med. 2009;103(8):1136-42.

Chemla D, Castelain V, Humbert M. New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest. 2004;126(4):1313-7

Councils ES. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart J. 2016;37:67-119.

Andersen CU, Mellemkjaer S, Hilberg O, Nielsen-Kudsk JE, Simonsen U, Bendstrup E. Pulmonary hypertension in interstitial lung disease: Prevalence, prognosis and 6 min walk test. Respir Med. 2012;106(6):875-82.

Neal JE, Lee AS, Burger CD. Sub maximal exercise testing may be superior to the 6-min walk test in assessing pulmonary arterial hypertension disease severity. Clin Respir J. 2014;8:404-9.

Ozpelit E, Akdeniz B, Sezgin D, Sevinc C, Tertemiz KC, Ozpelit ME, et al. Clinical and hemodynamic profiles of elderly patients with pulmonary arterial hypertension: a single center, prospective study. J Geriatr Cardiol. 2017;14(1):20-27.

Mehrotra R, Bansal M, Kasliwal RR, Trehan N. Epidemiological and clinical profile of pulmonary hypertension: data from an indian registry. J Clin Prev Cardiol. 2012;1:51-7.

Parthiban N, Selvarajan C, Nambiar R, Iype M. Clinical profile of pulmonary arterial hypertension patients-a tertiary care hospital based study. Sch J App Med Sci. 2017;5(11E):4661-5.

Launay D, Mouthon L, Hachulla E, Pagnoux C, de Groote P, Remy-Jardin M, et al. Prevalence and characteristics of moderate to severe pulmonary hypertension in systemic sclerosis with and without interstitial lung disease. J Rheumatol. 2007;34(5):1005-11.

Alzeer AH, Al-mobeirek AF, Al-otair HA, Elzamzamy UA, Joherjy IA, Shaffi AS. Right and left ventricular function and pulmonary artery pressure in patients with bronchiectasis. Chest. 2008;133:464-73.

Acar S, Savci S, KARADİBAK D, KAHRAMAN BÖ, Akdeniz B, ÖZPELİT E, Sevinc C. Clinical correlation between the 6-min walk test and cardiopulmonary exercise testing in patients with pulmonary arterial hypertension. Turkish J Med Sci. 2016;46(6):1658-64.

Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Euro Res J. 2008;32(5):1371-85.

Leuchte HH, Neurohr C, Baumgartner R, Holzapfel M, Giehrl W, Vogeser M, et al. Brain natriuretic peptide and exercise capacity in lung fibrosis and pulmonary hypertension. Ame J Res Critical Care Med. 2004;170(4):360-5.

Modrykamien AM, Gudavalli R, McCarthy K, Parambil J. Echocardiography, 6-minute walk distance, and distance saturation product as predictors of pulmonary arterial hypertension in idiopathic pulmonary fibrosis. Respir Care. 2010;5:584e8.

Nathan SD, Shlobin OA, Ahmad S, Urbanek S, Barnett SD. Pulmonary hypertension and pulmonary function testing in idiopathic pulmonary fibrosis. Chest. 2007;131(3):657-63.