Express: The incremental shuttle walk test predicts mortality in non-group 1 pulmonary hypertension: results from the ASPIRE Registry.

Pulmonary hypertension (PH) is classified into 5 groups based on disease etiology but there is only limited information on the prognostic value of exercise testing in non-Group 1 PH. In Group 1 PH the incremental shuttle walking test (ISWT) distance has been shown to correlate with pulmonary hemodynamics and predict survival without a ceiling-effect. This study assessed the ISWT in non-group 1 PH. Data were retrieved from the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) for consecutive patients diagnosed with PH. Patients were required to have been systematically assessed as Group 2-5 PH and to have a baseline ISWT within 3 months of cardiac catheterization. Patients were stratified according to incremental shuttle walk test distance (ISWD) and ISWT distance percent predicted (ISWD%pred). 479 patients with non-Group 1 PH were identified. ISWD and ISWD%pred correlated significantly with symptoms and hemodynamic severity. ISWD and ISWD%pred predicted survival with no ceiling-effect. The test was prognostic in Groups 2, 3 and 4. ISWD and ISWD%pred and change in ISWD and ISWD%pred at 1 year were all significant predictors of outcome. In patients with non-Group 1 PH the Incremental Shuttle Walk Test is a simple non-invasive test that is easy to perform, is predictive of survival at baseline and follow-up, reflects change and can be used in the assessment of PH of any etiology.