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Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension

Published online by Cambridge University Press:  16 September 2015

Mohammad R. Abumehdi ,
Andrew J. Wardle Open the ORCID record for Andrew J. Wardle [Opens in a new window] ,
Rewa Nazzal ,
Athanasios Charalampopoulos ,
Ingram Schulze-Neick ,
Graham Derrick ,
Shahin Moledina  and
Alessandro Giardini
Mohammad R. Abumehdi
Affiliation:
North Central Thames Foundation School, London, United Kingdom
Andrew J. Wardle
Affiliation:
North West Thames Foundation School, London, United Kingdom
Rewa Nazzal
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom
Athanasios Charalampopoulos
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom
Ingram Schulze-Neick
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom
Graham Derrick
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom
Shahin Moledina
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom
Alessandro Giardini*
Affiliation:
Cardiorespiratory Unit, Great Ormond Street Hospital, London, United Kingdom
*
Correspondence to: A. Giardini, MD, PhD, Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, United Kingdom. Tel: +44 207 4059200, Ext: 8006; Fax: +44 207 8138263; E-mail: mohammad.abumehdi@hotmail.co.uk
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Abstract

Background

Cardiopulmonary exercise testing helps prognosticate and guide treatment in adults with pulmonary hypertension. Concerns regarding its feasibility and safety limit its use in children with pulmonary hypertension. We aimed to assess the feasibility and safety of cardiopulmonary exercise testing in a large paediatric pulmonary hypertension cohort.

Methods

We reviewed all consecutive cardiopulmonary exercise tests performed between March, 2004 and November, 2013. The exclusion criteria were as follows: height <120 cm, World Health Organization class IV, history of exercise-induced syncope, or significant ischaemia/arrhythmias. Significant events recorded were as follows: patient-reported symptoms, arrhythmias, electrocardiogram abnormalities, and abnormal responses of arterial O2 saturation.

Results

A total of 98 children underwent 167 cardiopulmonary exercise tests. The median age was 14 years (inter-quartile range 10–15 years). Peak oxygen uptake was 20.4±7.3 ml/kg/minute, corresponding to 51.8±18.3% of the predicted value. Peak respiratory quotient was 1.08±0.16. All the tests except two were maximal, being terminated prematurely for clinical reasons. Baseline Oxygen saturation was 93.3±8.8% and was 81.2±19.5% at peak exercise. A drop in arterial O2 saturation >20% was observed in 23.5% of the patients. Moreover, five patients (3.0%) experienced dizziness, one requiring termination of cardiopulmonary exercise testing; five children (3.0%) experienced chest pain, with early cardiopulmonary exercise test termination in one patient. No significant arrhythmias or electrocardiogram changes were observed.

Conclusion

Exercise testing in non-severely symptomatic children with pulmonary hypertension is safe and practical, and can be performed in a large number of children with pulmonary hypertension in a controlled environment with an experienced team. Side-effects were not serious and were resolved promptly with test termination.

Keywords

Pulmonary hypertensionexercise testCHDsexercise physiology
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1144 - 1150
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Copyright
© Cambridge University Press 2015 

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References

1. Myers, J. Applications of cardiopulmonary exercise testing in the management of cardiovascular and pulmonary disease. Int J Sports Med 2005; 26 (Suppl): S49–S55.CrossRefGoogle ScholarPubMed
2. Yetman, AT, Taylor, AL, Doran, A, Ivy, DD. Utility of cardiopulmonary stress testing in assessing disease severity in children with pulmonary arterial hypertension. Am J Cardio 2005; 95: 697–699.CrossRefGoogle ScholarPubMed
3. Garofano, RP, Barst, RJ. Exercise testing in children with primary pulmonary hypertension. Pediatr Cardiol 1999; 20: 61–64.CrossRefGoogle ScholarPubMed
4. Wensel, R, Opitz, CF, Anker, SD, et al. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation 2002; 106: 319–324.CrossRefGoogle ScholarPubMed
5. Rausch, CM, Taylor, AL, Ross, H, Silau, S, Ivy, DD. Ventilatory efficiency slope correlates with functional capacity outcomes and disease severity in pediatric patients with pulmonary hypertension. Int J Cardiol 2013; 169: 445–448.CrossRefGoogle ScholarPubMed
6 Albouaini, K, Egred, M, Alahmar, A, Wright, DJ. Cardiopulmonary exercise testing and its application. Heart 2007; 93: 1285–1292.Google ScholarPubMed
7. Paridon, S, Alpert, B, Boas, S, et al. Clinical Stress Testing in the Pediatric Age Group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation 2006; 113: 1905–1920.CrossRefGoogle Scholar
8. Barst, RJ, Ertel, SI, Beghetti, M, Ivy, DD. Pulmonary arterial hypertension: a comparison between children and adults. Eu Respir J 2011; 37: 665–677.CrossRefGoogle ScholarPubMed
9. Smith, G, Reyes, JT, Russell, L, Humpl, T. Safety of maximal cardiopulmonary exercise testing in pediatric patients with pulmonary hypertension. Chest 2009; 135: 1209–1214.CrossRefGoogle ScholarPubMed
10. Casaburi, R, Marciniuk, D, Beck, K, et al. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003; 167: 211–277.Google Scholar
11. Lammers, AE, Diller, GP, Odendall, D, Tailor, S, Derrick, G, Haworth, S. Comparison of 6-min walk test distance and cardiopulmonary exercise test performance in children with pulmonary hypertension. Arch Dis Child 2011; 96: 141–147.CrossRefGoogle ScholarPubMed
12. Simmoneau, G, Robbins, IM, Beghetti, M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009; 54: S43–S54.CrossRefGoogle Scholar
13. Giardini, A, Odendaal, D, Khambadkone, S, Derrick, G. Physiologic decrease of ventilatory response to exercise in the second decade of life in healthy children. Am Heart J 2011; 161: 1214–1219.CrossRefGoogle ScholarPubMed
14. Giardini, A, Fenton, M, Andrews, RE, Derrick, G, Burch, M. Peak oxygen uptake correlates with survival without clinical deterioration in ambulatory children with dilated cardiomyopathy. Circulation 2011; 124: 1713–1718.CrossRefGoogle ScholarPubMed
15. Barst, RJ, Ivy, DD, Gaitan, G. A randomized, double-blind, placebo-controlled, dose-ranging study of oral sildenafil citrate in treatment-naive children with pulmonary arterial hypertension. Circulation 2012; 125: 324–334.CrossRefGoogle ScholarPubMed
16. Takken, T, Giardini, A, Reybrouck, T, et al. Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Trasnlational Research Section of the Europeaan Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology. Eur J Prev Cardiol 2012; 19: 1034–1065.CrossRefGoogle ScholarPubMed
17. Moledina, S, Hislop, A, Foster, H, Schulze-Neick, I, Haworth, S. Childhood idiopathic pulmonary arterial hypertension: a national cohort study. Heart 2010; 96: 1401–1406.CrossRefGoogle ScholarPubMed