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Decrease in Cerebral Oxygen Saturation During the 6-Minute Walk Test in Pediatric Pulmonary Arterial Hypertension

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Abstract

This observational study aimed to investigate the relationship between regional cerebral oxygen saturation (rSO2) during the 6-minute walk test (6-MWT) and the demographic/clinical features of patients with pulmonary arterial hypertension (PAH). Cerebral oxygenation was evaluated during the 6-MWT in 20 pediatric patients with PAH aged ≥ 7 years [13 male, 7 female; median age 12.25 (range 7–18) years]. In all patients, regional cerebral oxygen saturation    (rSO2), arterial oxygen saturation (SpO2), and heart rate (HR) were measured using near-infrared spectroscopy (NIRS) for 2 min before the test, during the 6-MWT test, and 2 min after the test. The relationship between the changes in rSO2, heart rate, and SpO2 values and clinical and laboratory features was compared statistically. The mean pulmonary arterial pressure (mPAP) was 77 (range 25–126) mmHg, and the median 6-minute walk distance (6-MWD) was 427.5 (300–570) m. The changes in rSO2 measurements ranged between 3.41 and 21.8%, and 70% of the patients had a greater than 10% decrease in rSO2 during the test compared with baseline. Eight patients showed a decrease in rSO2 without SpO2 changes. The present study demonstrated a significant decrease in cerebral oxygenation in pediatric patients with PAH during the 6-MWT. We hypothesized that using a combination of the 6-MWT and regional cerebral oxygenation monitoring in pediatric patients with PAH in order to evaluate exercise capacity, as a reflection of reduced daily activities, would provide more precise predictive values than the 6-MWT alone.

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References

  1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Rev Esp Cardiol 69:177

    Article  PubMed  Google Scholar 

  2. Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, Elliott CG, Gaine SP, Gladwin MT, Jing ZC, Krowka MJ, Langleben D, Nakanishi N, Souza R (2009) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 54:S43–54

    Article  PubMed  Google Scholar 

  3. Douwes JM, Hegeman AK, van der Krieke MB, Roofthooft MT, Hillege HL, Berger RM (2016) Six-minute walking distance and decrease in oxygen saturation during the six-minute walk test in pediatric pulmonary arterial hypertension. Int J Cardiol 202:34–39

    Article  PubMed  Google Scholar 

  4. Paolillo S, Farina S, Bussotti M, Iorio A, PerroneFilardi P, Piepolil MF, Agostoni P (2012) Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol 19:960–971

    Article  PubMed  Google Scholar 

  5. Paciocco G, Martinez FJ, Bossone E, Pielsticker E, Gillespie B, Rubenfire M (2001) Oxygen desaturation on the six-minute walk test and mortality in untreated primary pulmonary hypertension. Eur Respir J 17:647–652

    Article  CAS  PubMed  Google Scholar 

  6. Richter MJ, Grimminger J, Kruger B, Ghofrani HA, Mooren FC, Gall H, Pilat C, Kruger K (2017) Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension. Pulm Circ 7:20–37

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kula S, Canbeyli F, Atasayan V, Tunaoglu FS, Oguz AD (2018) A retrospective study on children with pulmonary arterial hypertension: a single-center experience. Anatol J Cardiol 20:41–47

    PubMed  PubMed Central  Google Scholar 

  8. Rooks CR, Thom NJ, McCully KK, Dishman RK (2010) Effects of incremental exercise on cerebral oxygenation measured by near-infrared spectroscopy: a systematic review. Prog Neurobiol 92:134–150

    Article  PubMed  Google Scholar 

  9. Wolf M, Ferrari M, Quaresima V (2007) Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. J Biomed Opt 12:062104

    Article  PubMed  Google Scholar 

  10. Chakravarti S, Srivastava S, Mittnacht AJ (2008) Near infrared spectroscopy (NIRS) in children. Semin Cardiothorac Vasc Anesth 12:70–79

    Article  PubMed  Google Scholar 

  11. Laboratories ATSCoPSfCPF (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  12. Secher NH, Seifert T, van Lieshout JJ (2008) Cerebral blood flow and metabolism during exercise: implications for fatigue. J Appl Physiol 104:306–314

    Article  CAS  PubMed  Google Scholar 

  13. Cahalin LP, Mathier MA, Semigran MJ, Dec GW, DiSalvo TG (1996) The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 110:325–332

    Article  CAS  PubMed  Google Scholar 

  14. Barbosa PB, Ferreira EM, Arakaki JS, Takara LS, Moura J, Nascimento RB, Nery LE, Neder JA (2011) Kinetics of skeletal muscle O2 delivery and utilization at the onset of heavy-intensity exercise in pulmonary arterial hypertension. Eur J Appl Physiol 111:1851–1861

    Article  PubMed  Google Scholar 

  15. Huppert TJ, Hoge RD, Diamond SG, Franceschini MA, Boas DA (2006) A temporal comparison of BOLD, ASL, and NIRS hemodynamic responses to motor stimuli in adult humans. Neuroimage 29:368–382

    Article  CAS  PubMed  Google Scholar 

  16. Perrey S (2008) Non-invasive NIR spectroscopy of human brain function during exercise. Methods 45:289–299

    Article  CAS  PubMed  Google Scholar 

  17. Nagdyman N, Fleck T, Bitterling B, Ewert P, Abdul-Khaliq H, Stiller B, Hübler M, Lange PE, Berger F, Schulze-Neick I (2006) Influence of intravenous sildenafil on cerebral oxygenation measured by near-infrared spectroscopy in infants after cardiac surgery. Pediatr Res 59(3):462–465

    Article  CAS  PubMed  Google Scholar 

  18. Sen AN, Gopinath SP, Robertson CS (2016) Clinical application of near-infrared spectroscopy in patients with traumatic brain injury: a review of the progress of the field. Neurophotonics 3(3):03140

    Article  Google Scholar 

  19. Yazıcı M, Livanelioğlu A, Gücüyener K, Tekin L, Sümer E, Yakut Y (2019) Effects of robotic rehabilitation on walking and balance in pediatric patients with hemiparetic cerebral palsy. Gait Posture 70:397–402

    Article  PubMed  Google Scholar 

  20. Weng WC, Chen JC, Lee CY, Lin CW, Lee WT, Shieh JY, Wang CC, Chuang CC (2018) Cross-section and feasibility study on the non-invasive evaluation of muscle hemodynamic responses in Duchenne muscular dystrophy by using a near-infrared diffuse optical technique. Biomed Opt Express 9(10):4767–4780

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Moreira MÂ, Medeiros GA, Boeno FP, Sanches PR, Silva Júnior DP, Müller AF (2014) Chronic obstructive pulmonary disease (COPD): oxygen desaturation during the six-minute walk test in COPD patients. Bras Pneumol 40(3):222–228

    Article  Google Scholar 

  22. Van Lieshout JJ, Pott F, Madsen PL, Van Goudoever J, Secher NH (2001) Muscle tension during standing: effect on cerebral artery blood velocity and oxygenation. Stroke 32:1546–1551

    Article  PubMed  Google Scholar 

  23. Holzschuh M, Woertgen C, Metz C, Brawanski A (1997) Dynamic changes of cerebral oxygenation measured by brain tissue oxygen pressure and near infrared spectroscopy. Neurol Res 19:246–248

    Article  CAS  PubMed  Google Scholar 

  24. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K (2000) Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487–492

    Article  CAS  PubMed  Google Scholar 

  25. Wagner BD, Takatsuki S, Accurso FJ, Ivy DD (2013) Evaluation of circulating proteins and hemodynamics towards predicting mortality in children with pulmonary arterial hypertension. PLoS ONE 8:e80235

    Article  PubMed  PubMed Central  Google Scholar 

  26. Barst RJ, McGoon MD, Elliott CG, Foreman AJ, Miller DP, Ivy DD (2012) Survival in childhood pulmonary arterial hypertension: insights from the registry to evaluate early and long-term pulmonary arterial hypertension disease management. Circulation 125:113–122

    Article  PubMed  Google Scholar 

  27. Zijlstra WMH, Douwes JM, Rosenzweig EB, Schokker S, Krishnan U, Roofthooft MTR, Miller-Reed K, Hillege HL, Ivy DD, Berger RMF (2014) Survival differences in pediatric pulmonary arterial hypertension: clues to a better understanding of outcome and optimal treatment strategies. J Am Coll Cardiol 63:2159–2169

    Article  PubMed  Google Scholar 

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey

    Leman Tekin Orgun, Zeynep Öztürk & Kıvılcım Gücüyener

  2. Department of Pediatric Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey

    Fatma Hayvacı Canbeyli & Serdar Kula

  3. Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey

    Dilek Yapar

  4. Pediatric Neurology Department, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey

    Leman Tekin Orgun

Authors
  1. Leman Tekin Orgun
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  2. Zeynep Öztürk
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  3. Fatma Hayvacı Canbeyli
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  4. Dilek Yapar
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  5. Kıvılcım Gücüyener
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  6. Serdar Kula
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Contributions

TO: conceptualized and designed the study, performed data collection, drafted the manuscript and constructed the tables and the figures for the manuscript. ZO and HC: conceptualized and designed the study, designed the data collection instruments, performed data collection, performed analysis, and drafted the initial manuscript. DY: performed data collection, performed analysis and constructed the tables and the figures for the manuscript. KG: conceptualized and designed the study, performed data collection, critically revised the article, and approved article. SK: supervised data collection, drafted the initial manuscript, and constructed the tables and the figures for the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Leman Tekin Orgun.

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The authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all patients included in the study and their parents or guardians.

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Orgun, L.T., Öztürk, Z., Canbeyli, F.H. et al. Decrease in Cerebral Oxygen Saturation During the 6-Minute Walk Test in Pediatric Pulmonary Arterial Hypertension. Pediatr Cardiol 40, 1494–1502 (2019). https://doi.org/10.1007/s00246-019-02174-4

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  • DOI: https://doi.org/10.1007/s00246-019-02174-4

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