Functional capacity testing in patients with pulmonary hypertension (PH) using the one-minute sit-to-stand test (1-min STST)

PLOS ONE RESEARCH ARTICLE Functional capacity testing in patients with pulmonary hypertension (PH) using the oneminute sit-to-stand test (1-min STST) Christina Kronberger ID1☯, Roya Anahita Mousavi ID1☯, Begüm Öztürk2, Robin Willixhofer1, Theresa-Marie Dachs1, René Rettl1, Luciana Camuz-Ligios1, Nima Rassoulpour1, Christoph Krall3, Brigitte Litschauer4, Roza Badr Eslam ID1* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Cardiology, Medical University of Vienna, Vienna, Austria, 2 Department of Cardiology, Clinic Favoriten, Vienna, Austria, 3 Center for Medical Data Science, Medical University of Vienna, Vienna, Austria, 4 Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria ☯ These authors contributed equally to this work. * Abstract Background OPEN ACCESS Citation: Kronberger C, Mousavi RA, Öztürk B, Willixhofer R, Dachs T-M, Rettl R, et al. (2023) Functional capacity testing in patients with pulmonary hypertension (PH) using the oneminute sit-to-stand test (1-min STST). PLoS ONE 18(3): e0282697. https://doi.org/10.1371/journal. pone.0282697 Editor: Jacquelyn Quin, VA Boston Healthcare System, UNITED STATES Received: November 20, 2022 Accepted: February 19, 2023 The one-minute sit-to-stand-test (1-min STST) is a quick, space saving test to evaluate functional capacity. Exercise testing plays an important role in the long-term follow-up of pulmonary hypertension (PH) patients and is currently evaluated using the six-minute-walk-test (6MWT). The aim of the study was to assess the convergent validity of the 1-min STST in patients with PH and its association with markers of PH severity. Methods We evaluated 106 PH patients with the 1-min-STST and 6MWT and measured cardiorespiratory parameters (heart rate, blood pressure, oxygen saturation) before and after test conduction. N-terminal pro brain-type natriuretic peptide (NT-proBNP), WHO functional class (WHOFC) and mean pulmonary artery pressure (mPAP) were defined as markers of PH severity. Published: March 9, 2023 Copyright: © 2023 Kronberger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Results Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Strong correlation was found between performances of 1-min STST and 6MWT (r = .711, p < .001), indicating convergent validity. Both tests were inversely associated with NTproBNP (STST: r = -.405, p < .001; 6MWT: r = -.358, p < .001), WHO-FC (STST: r = -.591, p < .001; 6MWT: r = -.643, p < .001) and mPAP (STST: r = -.280, p < .001; 6MWT: r = -.250, p < .001). Significant changes in cardiorespiratory parameters were observed in both tests (all p < 0.001). Further the post-exercise cardiorespiratory parameters correlated strongly between the 1-min STST and 6MWT (all r � .651, all p < .001). Funding: The authors received no specific funding for this work. Conclusion Competing interests: The authors have declared that no competing interests exist. Abbreviations: 1-min STST, One-minute sit-tostand test; 6MWD, Six-minute walk distance; The 1-min STST demonstrated good convergent validity with the 6MWT and was associated with markers of PH severity. Furthermore, both exercise tests caused similar cardiorespiratory responses. PLOS ONE | https://doi.org/10.1371/journal.pone.0282697 March 9, 2023 1 / 12 PLOS ONE 6MWT, Six-minute walk test; BDS, Borg Dyspnea Scale; BMI, Body mass index; CAMPHOR, Cambridge Pulmonary Hypertension Outcome Review; COPD, Chronic obstructive pulmonary disease; ESC, European Society of Cardiology; ERS, European Respiratory Society; mPAP, Mean pulmonary arterial pressure; NT-proBNP, Nterminal prohormone of brain natriuretic peptide; QoL, Quality of life; RHC, Right heart catheterization; WHO-FC, WHO functional class. The one-minute sit-to-stand test in pulmonary hypertension patients Introduction Pulmonary hypertension (PH) is a progressive disease defined by a mean pulmonary artery pressure (mPAP) � 20 mmHg measured by right heart catheterization (RHC) [1], that, if untreated subsequently results in right heart failure and death. With disease progression, patients develop worsening of dyspnea, fatigue, syncope and chest pain, which negatively impact functional capacity and quality of life. The 6-minute walk test (6MWT) is a well-established method to assess functional capacity in patients with PH and is recommended by current European Society of Cardiology (ESC)/ European Respiratory Society (ERS) guidelines for the diagnosis and treatment of PH [1]. However, it requires space and time and can therefore not always be performed in routine clinical practice. Recent studies suggest the use of the one-minute sit-to-stand test (1-min STST) as an alternative to the 6MWT in several cardiopulmonary diseases [2–6]. In this test the participant is encouraged to stand up and sit down from a chair as quickly and as many times as possible within one minute. The 1-min STST is easier applicable, because it does not require as much space as the 6MWT. Therefore, we hypothesize that the 1-min STST can be used as a surrogate for the 6MWT in patients with PH as previously suggested by Nakazato et al. [7]. A good correlation of 1-min STST and 6MWT has already been shown in patients with chronic obstructive pulmonary disease (COPD) [8] and cystic fibrosis [3], however, little is known on the agreement of 1-min STST performance and 6MWT performance in patients with PH. N-terminal prohormone of brain natriuretic peptide (NT-proBNP), WHO functional class (WHO-FC) and mean pulmonary artery pressure (mPAP) have been described as markers of PH severity [1, 9, 10]. The 6MWT was associated with PH severity markers in several studies [11–14], however, little is known about this association regarding the 1-min STST. The aim of our study was to assess the convergent validity of the 1-min STST with the 6MWT in patients with PH and its association with markers of PH severity. Additionally, we wanted to analyze whether cardiorespiratory parameters respond similar to both exercise tests. Methods Study design In this prospective, cross-sectional study data from PH patients at our specialized center were collected from March 2020 to July 2022. PH was defined as mPAP � 20 mmHg invasively measured by right heart catheterization [15, 16] which is in accordance with the current ESC/ ERS PH guidelines [1]. Patients performed the 1-min STST and 6MWT using a randomized test order by simple randomization method as described by Suresh et al. [17]. 46% of patients started with the 1-min STST and 54% started with the 6MWT followed by a resting period of 15 minutes as previously described [18]. All patients who were able to perform the two proposed exercise tests and gave their wri (...truncated)