BIBLIOS

Document type
Journal articles

Document subtype
Full paper

Title
Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population

Participants in the publication
Nuno Cotrim (Author)
Hugo M. Café (Author)
Jorge Guardado (Author)
Pedro Cordeiro (Author)
Hortense Cotrim (Author)
Rui Martins (Author)
Dep. Estatística e Investigação Operacional
Dep. Estatística e Investigação Operacional
CEAUL
CEAUL
Luís Baquero (Author)
Carlos Cotrim (Author)

Summary
Exercise stress echocardiography (ESE) is commonly employed in adults, but its applicability in pediatric populations remains to be clarified. Methods: A total of 309 consecutive children (C), with a mean age of 14.1 ± 2.6 years (range 6–17 years), underwent treadmill ESE starting in 2002. They were divided into two groups: Group I comprised 258 children, including 237 with symptoms related to exercise (such as chest pain, fatigue, lipothymia/syncope, or one aborted sudden death), 15 with electrocardiogram (ECG) abnormalities, and 6 with a positive ECG stress test showing ST changes. Group II consisted of 10 asymptomatic children whose parents requested routine screening, 11 with symptoms unrelated to exercise, 12 with a family history of sudden death, and 17 with known pathologies (including 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, and the remainder with various conditions, such as Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, and aortic switch operation). Regional wall motion abnormalities (RWMAs) and transvalvular or intraventricular (IVG) gradients were assessed using 2D and continuous-wave Doppler, respectively, in all cases. Results: The success rate was 100% (309/309). Stress-induced RWMAs were observed in two children. A significant IVG (>30 mmHg) was detected in 101 out of the 258 children (39%) in Group I, who presented with exercise-related symptoms, ECG abnormalities, or positive stress ECG. In Group I, the odds ratio (OR) of ESE reproducing the symptoms in children with IVG compared to those without IVG was 8.22 (95% CI: 4.84–13.99, p < 0.001). Conclusions: Treadmill ESE is both feasible and safe for pediatric populations. RWMAs demonstrated limited utility in our cohort of children, while IVG induced by exercise was frequently observed in symptomatic children.


Institution
FACULDADE DE CIÊNCIAS DA UNIVERSIDADE DE LISBOA

Where published
Journal of Clinical Medicine

Publication Identifiers
ISSN - 2077-0383

Publisher
MDPI AG



Document Identifiers
DOI - https://doi.org/10.3390/jcm13082191
URL - http://dx.doi.org/10.3390/jcm13082191

Rankings
SCIMAGO Q1 (2021) - 1,04 - Medicine (miscellaneous)