[Prognostic value of clinical exercise testing in idiopathic pulmonary fibrosis]

Rev Mal Respir. 2011 Mar;28(3):290-6. doi: 10.1016/j.rmr.2010.08.016. Epub 2011 Feb 22.
[Article in French]


Current guidelines for referring patients with idiopathic pulmonary fibrosis (IPF) for lung transplantation, based on resting parameters, are insufficient to predict 3-year mortality. The aim of this study was to determine the prognostic value of cardio-pulmonary exercise testing (CPET) in patients with IPF. A multicentre retrospective study of 3-year outcome was made on 63 adult patients with IPF who underwent CPET with blood gas analysis. Demographic data, resting pulmonary function and CPET parameters were collected to perform a univariate survival analysis. To estimate prognosis at 3 years, a multivariate logistic regression analysis by Kaplan-Meier curves and log-rank tests was performed. Forty-four patients (70%) were alive without lung transplant at the end of the 3-year follow-up: 19 patients (30%) were dead (n=14) or transplanted (n=5). Univariate analysis indicated that: at rest lower TLC, FVC, DLCO and PaCO(2), higher alveolo-arterial gradient for oxygen [P(A-a)O(2)] and pH; at ventilatory threshold (VT) higher VE/VO(2) and VE/VCO(2) and at peak exercise higher VE/VO(2) and VE/VCO(2), higher pH and ΔP(A-a)O(2)/ΔVO(2) (mmHg/L), lower VO(2) peak, PaO(2) and VO(2)/FC were associated with a significantly lower survival at 3 years. The multivariate logistic regression analysis showed that CPT (<65%) and VE/VO(2) at VT (>45) were independently associated with a lower survival at 3 years. Restriction and hyperventilation at ventilatory threshold are major prognostic factors in the course of IPF. CPET with blood gas analysis may have a prognostic value in these patients and initial evaluation of these parameters can help to predict disease progression.

Publication types

  • Comparative Study
  • English Abstract
  • Multicenter Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Blood Gas Analysis* / methods
  • Carbon Dioxide / blood*
  • Disease Progression
  • Exercise Test*
  • Female
  • France
  • Humans
  • Idiopathic Pulmonary Fibrosis / blood*
  • Idiopathic Pulmonary Fibrosis / diagnosis
  • Idiopathic Pulmonary Fibrosis / mortality
  • Idiopathic Pulmonary Fibrosis / physiopathology
  • Idiopathic Pulmonary Fibrosis / surgery
  • Lung Transplantation
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Oxygen / blood*
  • Prognosis
  • Pulmonary Gas Exchange
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Survival Analysis
  • Vital Capacity


  • Carbon Dioxide
  • Oxygen