Exercise tests and anxiety independently reflect physical quality of life in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

Background: Up to now, only few data existed evaluating quality of life in patients with PAH and/or CTEPH. Question: To describe the association between anxiety, depression, cardiopulmonary hemodynamics, and exercise parameters with physical quality of life (QoL). Methods: Patients with PAH and/or CTEPH performed a 6 minute walk test, cardiopulmonary exercise testing (CPET) and right heart catheterization and completed 3 QoL questionnaires (SF36, SRGQ and MacNew). Hospital Anxiety and Depression Scale (HADS) was used to assess psychological constructs like anxiety and depression. Results: 63 PAH und 22 CTEPH patients were prospectively included. Peak oxygen uptake (VO2 peak) during CPET was 13±4 ml/min/kg and 6 minute walk distance (6MWD) was 325±127 m. After multivariate analysis anxiety showed an independent association with activity, impact, and total scores in SGRQ and with emotional, physical, social and total scores in MacNew and with mental score in SF36. There was an independent correlation between depression and physical, mental and symptom scores in SF-36. Peak VO2 showed an independent association with all above mentioned subscales in SGRQ and with physical and mental QoL in SF36, whereas 6MWD was associated with all above mentioned scores of the MacNew and the symptom score of SF36. Conclusion: Peak VO2 and 6MWD reflect quality of life in patients with PAH and/or CTEPH. In addition, anxiety and depression showed a strong association with mental and physical QoL underlining the need for awareness of these disorders.