Usefulness of the Duke Activity Status Index to Assess Exercise Capacity and Predict Risk Stratification in Patients with Pulmonary Arterial Hypertension

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Apr 28

PMID 37109099

Authors

Haofeng Zhou

Yu Wang

Weiya Li

Lifang Yang

Yingxue Liao

Mingyu Xu

Caojin Zhang

Huan Ma

Affiliations

Soon will be listed here.

Abstract

Exercise capacity is an important component of risk assessment for pulmonary arterial hypertension (PAH). We investigated the association of the Duke Activity Status Index (DASI) with peak oxygen consumption (peakVO) and explored whether the DASI can discriminate the high-risk individuals in patients with PAH, according to peakVO < 11 mL/min/kg. A total of 89 patients were evaluated using cardiopulmonary exercise testing (CPET) and DASI. The correlation between the DASI and peakVO was measured by univariate analysis, and a receiver operating characteristic (ROC) curve analysis was conducted. The DASI was correlated with peakVO in the univariate analysis. The ROC curve analysis revealed that the DASI had a discriminative value for identifying the individuals with a high risk in PAH patients ( < 0.001), with an area under ROC curve (AUC) of 0.79 (95% CI: 0.67-0.92). Similar results were observed in patients with PAH associated with congenital heart disease (CHD-PAH), ( = 0.001), with an AUC of 0.80 (95% CI: 0.658-0.947). Therefore, DASI reflects exercise capacity in patients with PAH and has good ability to discriminate patients with a low risk and a high risk, and it may be included in the risk assessment of PAH.

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References

Coute R, Ehrenfeld J, Gupta D, Terekhov M, Wanderer J . Electronically self-assessed functional capacity and exercise testing: A comparison of the Duke Activity Status Index and Patient-Reported Outcomes Measurement Information System tools. Am Heart J. 2017; 188:82-86. DOI: 10.1016/j.ahj.2017.03.005. View

Fleisher L, Fleischmann K, Auerbach A, Barnason S, Beckman J, Bozkurt B . 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(24):2215-45. DOI: 10.1161/CIR.0000000000000105. View

Matura L, Shou H, Fritz J, Smith K, Vaidya A, Pinder D . Physical Activity and Symptoms in Pulmonary Arterial Hypertension. Chest. 2016; 150(1):46-56. PMC: 4980549. DOI: 10.1016/j.chest.2016.02.633. View

Parissis J, Nikolaou M, Birmpa D, Farmakis D, Paraskevaidis I, Bistola V . Clinical and prognostic value of Duke's Activity Status Index along with plasma B-type natriuretic peptide levels in chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2008; 103(1):73-5. DOI: 10.1016/j.amjcard.2008.08.045. View

Phillips L, Wang J, Pfeffer B, Gianos E, Fisher D, Shaw L . Clinical role of the Duke Activity Status Index in the selection of the optimal type of stress myocardial perfusion imaging study in patients with known or suspected ischemic heart disease. J Nucl Cardiol. 2011; 18(6):1015-20. DOI: 10.1007/s12350-011-9456-y. View

Malenfant S, Lebret M, Breton-Gagnon E, Potus F, Paulin R, Bonnet S . Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms. Eur Respir Rev. 2021; 30(160). PMC: 9488698. DOI: 10.1183/16000617.0284-2020. View

Shariat A, Cleland J, Danaee M, Alizadeh R, Sangelaji B, Kargarfard M . Borg CR-10 scale as a new approach to monitoring office exercise training. Work. 2018; 60(4):549-554. DOI: 10.3233/WOR-182762. View

Merz C, Olson M, McGorray S, Pakstis D, Zell K, Rickens C . Physical activity and functional capacity measurement in women: a report from the NHLBI-sponsored WISE study. J Womens Health Gend Based Med. 2000; 9(7):769-77. DOI: 10.1089/15246090050147745. View

Humbert M, Kovacs G, Hoeper M, Badagliacca R, Berger R, Brida M . 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022; 43(38):3618-3731. DOI: 10.1093/eurheartj/ehac237. View

10.

Potter E, Yang H, Wright L, Wang B, Marwick T . Measurement of Functional Capacity to Discriminate Clinical from Subclinical Heart Failure in Patients ≥65 Years of Age. Am J Cardiol. 2020; 127:84-91. DOI: 10.1016/j.amjcard.2020.03.051. View

11.

Wijeysundera D, Beattie W, Hillis G, Abbott T, Shulman M, Ackland G . Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. Br J Anaesth. 2019; 124(3):261-270. DOI: 10.1016/j.bja.2019.11.025. View

12.

Mustafaoglu R, Demir R, Kuran Aslan G, Sinan U, Zeren M, Kucukoglu M . Does Duke Activity Status Index help predicting functional exercise capacity and long-term prognosis in patients with pulmonary hypertension?. Respir Med. 2021; 181:106375. DOI: 10.1016/j.rmed.2021.106375. View

13.

Badagliacca R, Papa S, Poscia R, Valli G, Pezzuto B, Manzi G . The added value of cardiopulmonary exercise testing in the follow-up of pulmonary arterial hypertension. J Heart Lung Transplant. 2018; 38(3):306-314. DOI: 10.1016/j.healun.2018.11.015. View

14.

Savarese G, Paolillo S, Costanzo P, DAmore C, Cecere M, Losco T . Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension? A meta-analysis of 22 randomized trials. J Am Coll Cardiol. 2012; 60(13):1192-201. DOI: 10.1016/j.jacc.2012.01.083. View

15.

Meijer R, van Hooff M, Papen-Botterhuis N, Molenaar C, Regis M, Timmers T . Estimating VO in 18-90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire. Int J Gen Med. 2022; 15:3727-3737. PMC: 8994663. DOI: 10.2147/IJGM.S355589. View

16.

Li M, Bolshinsky V, Ismail H, Ho K, Heriot A, Riedel B . Comparison of Duke Activity Status Index with cardiopulmonary exercise testing in cancer patients. J Anesth. 2018; 32(4):576-584. DOI: 10.1007/s00540-018-2516-6. View

17.

Leber L, Beaudet A, Muller A . Epidemiology of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: identification of the most accurate estimates from a systematic literature review. Pulm Circ. 2021; 11(1):2045894020977300. PMC: 7797595. DOI: 10.1177/2045894020977300. View

18.

Hlatky M, Boineau R, Higginbotham M, Lee K, Mark D, Califf R . A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989; 64(10):651-4. DOI: 10.1016/0002-9149(89)90496-7. View

19.

George M, Kasbekar S, Bhagawati D, Hall M, Buscombe J . The value of the Duke Activity Status Index (DASI) in predicting ischaemia in myocardial perfusion scintigraphy - a prospective study. Nucl Med Rev Cent East Eur. 2011; 13(2):59-63. View

20.

. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-7. DOI: 10.1164/ajrccm.166.1.at1102. View