Sit-to-stand chair test may predict adverse outcomes in PH: Study
Worse performance associated with more hospitalization, lower survival rate
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The one-minute sit-to-stand test (STST), which measures the number of times a patient can sit down and stand up from a chair in 1 min, may predict adverse outcomes in adults with pulmonary hypertension (PH), according to a study.
In particular, worse performance in the STST (14 repetitions or fewer) was associated with more hospitalizations, shorter time to hospitalization, and a lower survival rate.
“Our findings show that the 1-min STST is a significant and independent predictor of long-term adverse outcomes, making it a feasible and easy-to-administer tool for assessing functional capacity and long-term mortality risk in PH patients,” researchers wrote. “Its implementation in routine visits could … allow clinicians to personalize monitoring intervals and treatment decisions based on individual patient risk profiles.”
The study, “Performance on the one-minute sit-to-stand test predicts long-term adverse outcomes in pulmonary hypertension,” was published in the Scientific Reports.
Functional capacity a strong predictor of death in PH
PH is characterized by abnormally high blood pressure (hypertension) in the pulmonary arteries, the blood vessels that carry blood through the lungs. This leads to PH symptoms such as shortness of breath, fatigue, and chest pain.
Functional capacity is a strong predictor of death in PH, and is commonly assessed with the six-minute walk test (6MWT), which measures the distance patients can walk in six minutes on a flat, hard surface.
The STST, proposed as a simple and reproducible measure, may also be used to assess functional capacity. In patients with pulmonary hypertension, the STST is associated with the 6MWT and validated markers of functional status and disease severity.
However, “its ability to correctly identify patients at high risk for long-term adverse outcomes has not been investigated,” the researchers wrote.
About half of patients had adverse event over 2.7 years
To learn more, a research team conducted a study of adults with PH enrolled at the Medical University of Vienna in Austria who underwent both the 6MWT and the STST. A total of 117 participants (56% women) were included. Their mean age was 66 years.
Over a median follow-up of 2.7 years, about half of the patients had an adverse event, defined as a composite of PH-related hospitalizations, transplants, or death due to any cause. This included 42 participants hospitalized at least once, 13 who died, and five patients who underwent a lung or heart transplant.
Those with adverse events were significantly older (70 years vs. 63 years), had higher levels of NT-proBNP (1287 picograms/mL vs. 401 picograms/mL), a marker of heart damage, and more often had a higher World Health Organization functional class (class III/IV: 70% vs. 40%), meaning more severe symptoms.
Cardiovascular risk factors such as smoking, hypertension, and high blood fats, as well as the need for long-term oxygen therapy, were also more common among participants with adverse events. They also had higher mean pulmonary artery pressure (mPAP; 44 mmHg vs. 37 mmHg), an indicator of PH, as well as worse performance on the 6MWT (304 vs. 402 meters, or 332 vs. 440 yards) and STST tests (15 vs. 18 repetitions).
Our findings underscore the broader clinical value of assessing functional capacity in PH.
Based on previously published cutoff values for the STST, about one-third of the patients were categorized as low-risk (20 or more repetitions), intermediate-risk (15 to 19 repetitions), and high-risk (14 repetitions or fewer) for adverse events.
Further analysis indicated that high-risk patients had more adverse events compared with those with intermediate or low risk. Each additional repetition on STST was associated with a 6% reduction in the risk of experiencing adverse outcomes. Being able to do five more repetitions correlated with a 27% lower risk.
This association remained significant after adjusting for age, sex, body mass index (a measure of body fat), NT-proBNP levels, and major coexisting conditions, including heart problems, diabetes, and hypertension. However, statistical significance was no longer seen after adjusting for PH severity markers.
High-risk patients also had significantly shorter times to first and second hospitalizations, a higher rate of hospitalizations, and reduced survival.
“Our findings underscore the broader clinical value of assessing functional capacity in PH,” the researchers wrote. “The 1-min STST is simple and low-cost, making it especially attractive for routine use in healthcare environments where tests like the 6MWT or cardiopulmonary exercise testing may not be feasible.”
