The simple, noninvasive, easy to perform Incremental Shuttle Walk Test (ISWT) reflects change and is predictive of survival in patients with both Group 1 (pulmonary arterial hypertension [PAH]) and Groups 2, 3, and 4 pulmonary hypertension (PH), according to a study published in Pulmonary Circulation.

Researchers previously used data retrieved from the Assessing the Spectrum of Pulmonary Hypertension Identified at a Referral Centre (ASPIRE) registry to demonstrate that distance walked in the ISWT by patients with PAH correlates with pulmonary hemodynamic severity, resting Borg score, and World Health Organization (WHO) functional class, and predicts outcomes without a ceiling effect.

The current study was designed to assess ISWT usefulness in individuals with non-Group 1 PH (n=479). Participants were stratified according to incremental shuttle walk test distance (ISWD) and ISWD percent predicted (ISWD%pred).

In Groups 2, 3, and 4 PH, ISWD and ISWD%pred significantly correlated with symptom severity (Borg score and WHO functional class), and with hemodynamic parameters, including pulmonary vascular resistance, right atrial pressure, mixed venous oxygen saturation, cardiac index, and cardiac output (P <.001 for all). ISWD and ISWD%pred also predicted long-term survival and 1-year survival in both younger patients (area under the ROC curve [AUROC], 0.678; 95% CI, 0.587-0.770 and 0.707; 0.621-0.792, respectively), and the elderly (AUROC 95% CI, 0.670; 95% CI, 0.557-0.776 and 0.701; 95%, 0.600-0.802])

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The investigators concluded, “The Incremental Shuttle Walk Test is a simple noninvasive test that is easy to perform in patients with non-Group 1 PH, is predictive of survival at baseline and follow-up, and reflects change. We have demonstrated that the ISWT can be used to predict outcomes in both group 1 and non-Group 1 pulmonary hypertension.”


Billings CG, Lewis R, Hurdman JA, et al. Express: the incremental shuttle walk test predicts mortality in non-group 1 pulmonary hypertension: results from the ASPIRE Registry [published online April 18, 2019]. Pulm Circ. doi:10.1177/2045894019848649

This article originally appeared on Pulmonology Advisor