Skip to main content
Erschienen in: Pediatric Cardiology 7/2019

31.07.2019 | Original Article

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

verfasst von: Leman Tekin Orgun, Zeynep Öztürk, Fatma Hayvacı Canbeyli, Dilek Yapar, Kıvılcım Gücüyener, Serdar Kula

Erschienen in: Pediatric Cardiology | Ausgabe 7/2019

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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 69:177CrossRefPubMed 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 69:177CrossRefPubMed
2.
Zurück zum Zitat 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:S43–54CrossRefPubMed 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:S43–54CrossRefPubMed
3.
Zurück zum Zitat 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 202:34–39CrossRefPubMed 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 202:34–39CrossRefPubMed
4.
Zurück zum Zitat 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 19:960–971CrossRefPubMed 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 19:960–971CrossRefPubMed
5.
Zurück zum Zitat 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 17:647–652CrossRefPubMed 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 17:647–652CrossRefPubMed
6.
Zurück zum Zitat 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 7:20–37CrossRefPubMedPubMedCentral 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 7:20–37CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat 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 20:41–47PubMedPubMedCentral 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 20:41–47PubMedPubMedCentral
8.
Zurück zum Zitat 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 92:134–150CrossRefPubMed 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 92:134–150CrossRefPubMed
9.
Zurück zum Zitat Wolf M, Ferrari M, Quaresima V (2007) Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. J Biomed Opt 12:062104CrossRefPubMed Wolf M, Ferrari M, Quaresima V (2007) Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. J Biomed Opt 12:062104CrossRefPubMed
10.
Zurück zum Zitat Chakravarti S, Srivastava S, Mittnacht AJ (2008) Near infrared spectroscopy (NIRS) in children. Semin Cardiothorac Vasc Anesth 12:70–79CrossRefPubMed Chakravarti S, Srivastava S, Mittnacht AJ (2008) Near infrared spectroscopy (NIRS) in children. Semin Cardiothorac Vasc Anesth 12:70–79CrossRefPubMed
11.
Zurück zum Zitat Laboratories ATSCoPSfCPF (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRef Laboratories ATSCoPSfCPF (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRef
12.
Zurück zum Zitat Secher NH, Seifert T, van Lieshout JJ (2008) Cerebral blood flow and metabolism during exercise: implications for fatigue. J Appl Physiol 104:306–314CrossRefPubMed Secher NH, Seifert T, van Lieshout JJ (2008) Cerebral blood flow and metabolism during exercise: implications for fatigue. J Appl Physiol 104:306–314CrossRefPubMed
13.
Zurück zum Zitat 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 110:325–332CrossRefPubMed 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 110:325–332CrossRefPubMed
14.
Zurück zum Zitat 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 111:1851–1861CrossRefPubMed 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 111:1851–1861CrossRefPubMed
15.
Zurück zum Zitat 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 29:368–382CrossRefPubMed 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 29:368–382CrossRefPubMed
16.
Zurück zum Zitat Perrey S (2008) Non-invasive NIR spectroscopy of human brain function during exercise. Methods 45:289–299CrossRefPubMed Perrey S (2008) Non-invasive NIR spectroscopy of human brain function during exercise. Methods 45:289–299CrossRefPubMed
17.
Zurück zum Zitat 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):462–465CrossRefPubMed 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):462–465CrossRefPubMed
18.
Zurück zum Zitat 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):03140CrossRef 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):03140CrossRef
19.
Zurück zum Zitat 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 70:397–402CrossRefPubMed 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 70:397–402CrossRefPubMed
20.
Zurück zum Zitat 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):4767–4780CrossRefPubMedPubMedCentral 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):4767–4780CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat 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):222–228CrossRef 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):222–228CrossRef
22.
Zurück zum Zitat 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 32:1546–1551CrossRefPubMed 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 32:1546–1551CrossRefPubMed
23.
Zurück zum Zitat 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 19:246–248CrossRefPubMed 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 19:246–248CrossRefPubMed
24.
Zurück zum Zitat 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 161:487–492CrossRefPubMed 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 161:487–492CrossRefPubMed
25.
Zurück zum Zitat 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:e80235CrossRefPubMedPubMedCentral 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:e80235CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat 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 125:113–122CrossRefPubMed 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 125:113–122CrossRefPubMed
27.
Zurück zum Zitat 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 63:2159–2169CrossRefPubMed 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 63:2159–2169CrossRefPubMed
Metadaten
Titel
Decrease in Cerebral Oxygen Saturation During the 6-Minute Walk Test in Pediatric Pulmonary Arterial Hypertension
verfasst von
Leman Tekin Orgun
Zeynep Öztürk
Fatma Hayvacı Canbeyli
Dilek Yapar
Kıvılcım Gücüyener
Serdar Kula
Publikationsdatum
31.07.2019
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 7/2019
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-019-02174-4

Weitere Artikel der Ausgabe 7/2019

Pediatric Cardiology 7/2019 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.