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Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors

Todd M. Tartavoulle, Aryn C. Karpinski, Andrew Aubin, Benzi M. Kluger, Oliver Distler, Lesley Ann Saketkoo
ERJ Open Research 2018 4: 00079-2017; DOI: 10.1183/23120541.00079-2017
Todd M. Tartavoulle
1School of Nursing, Louisiana State University Health Sciences Center – New Orleans, New Orleans, LA, USA
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Aryn C. Karpinski
2Evaluation and Measurement, School of Foundations, Leadership and Administration, Kent State University, Kent, OH, USA
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Andrew Aubin
3School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Benzi M. Kluger
4Dept of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Oliver Distler
5Dept of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Lesley Ann Saketkoo
6New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA
7Tulane Lung Center, Tulane University School of Medicine, New Orleans, LA, USA
8University Medical Center, Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, LA, USA
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  • FIGURE 1
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    FIGURE 1

    Distribution of fatigue severity among the Multidimensional Fatigue Inventory-20 fatigue dimensions.

Tables

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  • TABLE 1

    Patient characteristics

    Subjects120
    Age years52.61±14.0
    Sex
     Male14 (11.7)
     Female106 (88.3)
    Race
     White103 (85.8)
     Other17 (14.2)
      African-American/Black7 (5.8)
      Hispanic or Latino6 (5.0)
      Asian2 (1.7)
      Native American2 (1.7)
    BMI
     Less than obese62 (51.7)
      Underweight (BMI <18.5 kg·m−2)2 (1.7)
      Healthy weight (BMI 18.5–24.9 kg·m−2)27 (22.5)
      Overweight (BMI 25.0–29.9 kg·m−2)33 (27.5)
     Obese (BMI ≥30 kg·m−2)58 (48.3)
    WHO group I breakdown
     Idiopathic67 (55.8)
     Other53 (44.2)
      Connective tissue disease16 (13.3)
      Unknown13 (10.8)
      Congenital heart disease7 (5.8)
      Drug/toxin induced4 (3.3)
      Heritable3 (2.5)
      Idiopathic with heritable3 (2.5)
      Other7 (5.7)
    NYHA Functional Class
     I/II81 (67.5)
      I11 (9.2)
      II70 (58.3)
     III/IV39 (32.5)
      III35 (29.2)
      IV4 (3.3)
    Oxygen use63 (52.5)
    Medications
     PGI28 (6.6)
     PDEI15 (12.5)
     ERA9 (7.5)
     PGI2+PDEI25 (20.8)
     PGI2+ERA7 (5.8)
     PDEI+ERA20 (16.7)
     PGI2+PDEI+ERA23 (19.2)

    Data are presented as n, mean±sd or n (%). BMI: body mass index; WHO: World Health Organization; NYHA: New York Heart Association; PGI2: prostaglandin I2; PDEI: phosphodiesterase inhibitor; ERA: endothelin receptor antagonist.

    • TABLE 2

      Fatigue dimension and patient# characteristics

      PatientsReduced ActivityReduced MotivationGeneral FatiguePhysical FatigueMental FatigueTotal
      Sex
       Male1411.21±2.99
      (5–15)
      9.57±2.90
      (5–14)
      12.43±3.06
      (7–18)
      12.79±2.88
      (7–17)
      10.36±3.39
      (6–17)
      56.36±12.07
      (34–71)
       Female10611.35±4.31
      (4–20)
      10.40±3.67
      (4–20)
      13.53±3.67
      (4–20)
      13.29±3.77
      (4–20)
      10.43±4.06
      (4–20)
      59.00±15.16
      (26–92)
      Race
       White10311.46±4.16
      (4–20)
      10.51±3.56
      (4–20)
      13.55±3.56
      (5–20)
      13.36±3.66
      (4–20)
      10.42±3.90
      (4–20)
      59.30±14.75
      (27–92)
       Other1710.59±4.23
      (4–17)
      9.00±3.61
      (4–18)
      12.47±3.91
      (4–19)
      12.47±3.73
      (6–20)
      10.47±4.57
      (4–19)
      55.00±17.50
      (26–87)
      BMI
       Less than obese629.85±3.79
      (4–20)
      9.52±3.42
      (4–20)
      13.11±3.27
      (6–20)
      12.23±3.72
      (4–19)
      8.63±3.21
      (4–18)
      53.34±13.08
      (26–78)
       Obese5812.91***±3.99
      (4–20)
      11.14*±3.61
      (4–19)
      13.71±3.95
      (4–20)
      14.31**±3.32
      (7–20)
      12.34***±3.84
      (4–20)
      64.41***±15.24
      (26–92)
      PAH
       Idiopathic6711.28±4.33
      (4–20)
      10.37±3.87
      (4–20)
      13.40±3.60
      (5.20)
      13.58±4.06
      (4–20)
      10.54±4.19
      (4.20)
      59.18±16.08
      (26–91)
       Other5311.40±3.98
      (4–20)
      10.21±3.24
      (4–19)
      13.40±3.66
      (4–20)
      12.79±3.09
      (6–20)
      10.28±3.72
      (4–19)
      58.08±14.03
      (26–92)
      NYHA Functional Class
       I/II8110.17±4.05
      (4–20)
      9.25±3.28
      (4–20)
      13.19±3.89
      (4–20)
      12.60±3.94
      (4–20)
      9.36±3.58
      (4–20)
      54.57±14.99
      (26–91)
       III/IV3913.74***±3.31
      (6–20)
      12.49***±3.22
      (6–19)
      13.85±2.95
      (8–20)
      14.54**±2.63
      (10–20)
      12.64***±3.89
      (5–20)
      67.26***±11.61
      (43–92)
      Oxygen use6312.10*±4.17
      (4–20)
      10.95*±3.44
      (4–20)
      14.32**±3.11
      (6–20)
      13.89*±3.13
      (6–20)
      11.37**±3.74
      (4–20)
      62.62**±13.27
      (27–92)

      Data are presented as n or mean±sd (minimum–maximum). BMI: body mass index; PAH: pulmonary arterial hypertension; NYHA: New York Heart Association. For oxygen use, only “Yes” descriptive statistics are reported. #: n=120 patients. *: p<0.05; **: p<0.01; ***: p<0.001. Asterisks follow the higher mean for the fatigue dimension.

      • TABLE 3

        Fatigue dimension scores and medication use

        SubjectsReduced ActivityReduced MotivationGeneral FatiguePhysical FatigueMental FatigueTotal
        PGI2811.42±3.98
        (4–20)
        11.00*±3.67
        (4–20)
        14.00±3.71
        (5–20)
        13.65±3.57
        (4–20)
        11.03±4.33
        (4–20)
        61.10±14.54
        (28–91)
        PDEI1511.51±4.02
        (4–20)
        10.63±3.64
        (4–20)
        13.77±3.39
        (5–20)
        13.43±3.51
        (4–20)
        10.57±4.03
        (4–20)
        59.90±14.51
        (27–92)
        ERA911.42±4.17
        (4–19)
        10.31±4.00
        (4–20)
        13.73±3.66
        (5–20)
        12.88±4.00
        (5–20)
        10.17±4.14
        (4–19)
        58.52±15.98
        (26–87)
        PGI2+PDEI2511.79±3.97
        (4–20)
        11.32*±3.62
        (4–20)
        14.49**±3.59
        (5–20)
        13.81±3.57
        (4–20)
        11.28±4.48
        (4–20)
        62.68*±14.24
        (28–91)
        PGI2+ERA712.19±3.50
        (4–19)
        11.50±3.87
        (4–20)
        14.92*±3.48
        (5–20)
        13.46±3.73
        (5–20)
        11.85±4.54
        (4–19)
        63.92*±13.67
        (33–87)
        PDEI+ERA2011.03±3.96
        (4–19)
        10.42±4.15
        (4–20)
        13.92±3.46
        (5–20)
        12.81±3.64
        (6–20)
        10.53±4.40
        (4–19)
        58.69±15.55
        (27–87)
        PGI2+PDEI+ERA2312.71±3.33
        (5–19)
        11.90*±4.06
        (4–20)
        15.57**±3.20
        (5–20)
        14.00±3.52
        (7–20)
        12.05*±4.60
        (4–19)
        66.24*±12.78
        (34–87)

        Data are presented as n or mean±sd (minimum–maximum). PGI2: prostaglandin I2; PDEI: phosphodiesterase inhibitor; ERA: endothelin receptor antagonist. Only “Yes” descriptive statistics are reported. *: p<0.05; **: p<0.01. Asterisks follow the higher mean for the fatigue dimension.

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        Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors
        Todd M. Tartavoulle, Aryn C. Karpinski, Andrew Aubin, Benzi M. Kluger, Oliver Distler, Lesley Ann Saketkoo
        ERJ Open Research Jan 2018, 4 (1) 00079-2017; DOI: 10.1183/23120541.00079-2017

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        Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors
        Todd M. Tartavoulle, Aryn C. Karpinski, Andrew Aubin, Benzi M. Kluger, Oliver Distler, Lesley Ann Saketkoo
        ERJ Open Research Jan 2018, 4 (1) 00079-2017; DOI: 10.1183/23120541.00079-2017
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