Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR. 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 (Impact Factor: 14.43). 05/2006; 113(15):1905-20. DOI: 10.1161/CIRCULATIONAHA.106.174375
Source: PubMed


This statement is an updated report of the American Heart Association's previous publications on exercise in children. In this statement, exercise laboratory requirements for environment, equipment, staffing, and procedures are presented. Indications and contraindications to stress testing are discussed, as are types of testing protocols and the use of pharmacological stress protocols. Current stress laboratory practices are reviewed on the basis of a survey of pediatric cardiology training programs.

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    • "Peak oxygen consumption was measured in each test as the highest attained oxygen consumption that occurred beyond the anaerobic threshold. The VO 2 at the ventilatory anaerobic threshold was detected with the V-slope method supplemented by the simultaneous observation of end-tidal gas concentrations [12]. Ventilatory efficiency was measured by plotting VE against VCO 2 [6]. "
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    ABSTRACT: Cardiopulmonary exercise testing is widely used in a variety of cardiovascular conditions. Ventilatory efficiency slope can be derived from submaximal exercise testing. The present study sought to evaluate the relationship between ventilatory efficiency slope and functional capacity, outcomes, and disease severity in pediatric patients with pulmonary hypertension. Seventy six children and young adults with a diagnosis of pulmonary hypertension (PH) performed 258 cardiopulmonary exercise tests from 2001 to 2011. Each individual PH test was matched to a control test. Ventilatory efficiency slope was compared to traditional measures of functional capacity and disease severity including WHO functional classification, peak oxygen consumption, and invasive measures of pulmonary arterial pressures and pulmonary vascular resistance. Ventilatory efficiency slope was significantly higher in patients with pulmonary arterial hypertension, with an estimated increase of 7.2 for each increase in WHO class (p<0.0001), compared with normal control subjects (38.9 vs. 30.9, p<0.001). Ventilatory efficiency slope correlated strongly with invasive measures of disease severity including pulmonary vascular resistance index (r =0.61), pulmonary artery pressure (r =0.58), mean pulmonary artery pressure/mean aortic pressure ratio (r =0.52), and peak VO2 (r=-0.58). Ventilatory efficiency slope in 12 patients with poor outcomes (9 death, 3 lung transplant), was significantly elevated compared to patients who did not (51.1 vs. 37.9, p<0.001). Ventilatory efficiency slope correlates well with invasive and noninvasive markers of disease severity including peak VO2, WHO functional class, and catheterization variables in pediatric patients with PH. Ventilatory efficiency slope may be a useful noninvasive marker for disease severity.
    Full-text · Article · Oct 2013 · International journal of cardiology
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    • "Participants completed the McMaster protocol, a cycling protocol tailored to height and sex [23], on a cycle ergometer (Corival Pediatric, Lode B.V., the Netherlands; Technogym Bike Med, Technogym USA Corp., Seattle, WA) suited to the child's stature. The test consisted of two-minute stages at incremental workloads until the participant reached volitional exhaustion, failed to sustain the desired workload [24], requested to stop, stood up on the bike pedals, or experienced fatigue-related symptoms [25]. "
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    ABSTRACT: Heart rate recovery (HRR) is an indicator of all-cause mortality in children and adults. We aimed to determine the effect of adiposity and Prader-Willi Syndrome (PWS), a congenital form of obesity, on HRR. Sixteen children of normal weight (NW = body fat % ≤85th percentile, 9.4 ± 1.1 y), 18 children with obesity (OB = body fat % >95th percentile, 9.3 ± 1.1 y), and 11 PWS youth (regardless of body fat %; 11.4 ± 2.5 y) completed peak and submaximal bike tests on separate visits. HRR was recorded one minute following peak and submaximal exercises. All groups displayed similar HRR from peak exercise, while NW (54 ± 16 beats) and OB (50 ± 12 beats) exhibited a significantly faster HRR from submaximal exercise than PWS (37 ± 14 beats). These data suggest that excess adiposity does not influence HRR in children, but other factors such as low cardiovascular fitness and/or autonomic dysfunction might be more influential.
    Full-text · Article · May 2013 · Journal of obesity
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    • "ventilatory threshold). While a test duration of 10 ± 2 min has been recommended to allow the patient to reach their limit of tolerance [3] [4]. Midgley et al. nuanced this recommendation by suggesting that cycle ergometer tests should last between 7 and 26 min with a focus on tolerable workload increments rather than test duration, per se [5]. "
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    ABSTRACT: Background: There is no single optimal exercise testing protocol for children and adolescents with cystic fibrosis (CF) that differs widely in age and disease status. The aim of this study was to develop a CF-specific, individualized approach to determine workload increments for a cycle ergometry testing protocol. Methods: A total of 409 assessments consisting of maximal exercise data, anthropometric parameters, and lung function measures from 160 children and adolescents with CF were examined. 90% of the database was analyzed with backward linear regression with peak workload (W(peak)) as the dependent variable. Afterwards, we [1] used the remaining 10% of the database (model validation group) to validate the model's capacity to predict W(peak) and [2] validated the protocol's ability to provide a maximal effort within a 10±2 minute time frame in 14 adolescents with CF who were tested using this new protocol (protocol validation group). Results: No significant differences were seen in W(peak) and predicted W(peak) in the model validation group or in the protocol validation group. Eight of 14 adolescents with CF in the protocol validation group performed a maximal effort, and seven of them terminated the test within the 10±2 minute time frame. Backward linear regression analysis resulted in the following equation: W(peak) (W)=-142.865+2.998×Age (years)-19.206×Sex (0=male; 1=female)+1.328×Height (cm)+23.362×FEV(1) (L) (R=.89; R(2)=.79; SEE=21). Bland-Altman analysis showed no systematic bias between the actual and predicted W(peak). Conclusion: We developed a CF-specific linear regression model to predict peak workload based on standard measures of anthropometry and FEV(1), which could be used to calculate individualized workload increments for a cycle ergometry testing protocol.
    Full-text · Article · Jun 2012 · Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society
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