Maximal Exercise Testing Using the Incremental Shuttle Walking Test Can Be Used to Risk-Stratify Patients with Pulmonary Arterial Hypertension

Figure 1.. Kaplan-Meier survival curves for (A) incremental shuttle walking test distance in all pulmonary hypertension and (B) incremental shuttle walking test distance in idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension due to connective tissue disease. CTEPH = chronic thromboembolic pulmonary hypertension; IPAH = idiopathic pulmonary arterial hypertension; LHD = left heart disease; PAH = pulmonary arterial hypertension; PAH-CTD = pulmonary arterial hypertension due to connective tissue disease; PH = pulmonary hypertension.

Figure 2.. Kaplan-Meier survival curves for (A) incremental shuttle walking test distance risk groups at baseline, (B) transition of incremental shuttle walking test distance risk groups between baseline and follow-up, and (C) comparison of patients who, at follow-up, achieved at least one higher incremental shuttle walking test level, achieved the same incremental shuttle walking test level, or achieved a lower level than at baseline.

Figure 3.. A scatterplot showing individual baseline and follow-up incremental shuttle walking test distances and mortality or transplant within 1-year of follow-up incremental shuttle walking test distance in patients with idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension due to connective tissue disease (n = 879). ISWD = incremental shuttle walking test distance.

Figure 4.. Kaplan-Meier analysis demonstrating survival in (A) French Pulmonary Hypertension Registry low-risk approach; (B) REVEAL (Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management) 2.0 variation 1 (incremental shuttle walking test distance [ISWD] 0–180 m = +1 point, 190–330 m = 0 points, 340–420 m = −1 point, and ≥430 m = −2 points); (C) REVEAL 2.0 variation 2 (ISWD 0–180 m = +1 point, 190–330 m = 0 points, and ≥340 m = −1 point); and (D) REVEAL 2.0 variation 3 (ISWD 0–30 m = +2 points, 40–180 m = +1 point, 190–330 m = 0 points, 340–420 m = −1 point, and ≥430 m = −2 points).

Figure 5.. Risk of mortality by REVEAL (Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management) 2.0 score, using variations of REVEAL 2.0 incorporating incremental shuttle walking test distance (ISWD) as follows: REVEAL 2.0 variation 1 (ISWD 0–180 m = +1 point, 190–330 m = 0 points, 340–420 m = −1 point, and ≥430 m = −2 points), REVEAL 2.0 variation 2 (ISWD 0–180 m = +1 point, 190–330 m = 0 points, and ≥340 m = −1 point), and REVEAL 2.0 variation 3 (ISWD 0–30 m = +2 points, 40–180 m = +1 point, 190 = 330 m = 0 points, 340–420 m = −1 point, and ≥430 m = −2 points).