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Pediatric Cardiology

, Volume 40, Issue 7, pp 1516–1522 | Cite as

Correlation of Echocardiogram and Exercise Test Data in Children with Aortic Stenosis

  • Stephanie Santana
  • Samuel S. Gidding
  • Sherlly Xie
  • Tiancong Jiang
  • Rami Kharouf
  • Bradley W. RobinsonEmail author
Original Article

Abstract

Previous pediatric exercise test criteria for aortic stenosis severity were based on cardiac catheterization assessment, whereas current criteria are based on echocardiographic valve gradients. We sought to correlate exercise test criteria with echocardiographic assessment of severity. We report 65 studies, 51 patients (mean age of 13 ± 4 years; 75% males), with aortic stenosis (AS) who had a maximal exercise test between 2005 and 2016. We defined three groups based on resting mean Doppler gradient across their aortic valve: severe AS (n = 10; gradient of ≥ 40 mmHg), moderate AS (n = 20; gradient 25–39 mmHg), and mild AS (n = 35; gradient ≤ 24 mmHg). We studied symptoms (chest pain) during exercise, resting electrocardiogram changes (left ventricular hypertrophy [LVH]), complex arrhythmias during exercise, change in exercise systolic blood pressure (SBP; delta SBP = peak SBP-resting SBP), exercise duration, work, echocardiogram parameters (LVH), and ST–T wave changes with exercise. Additionally, we compared work and delta SBP during exercise with 117 control males and females without heart disease. Severe AS patients have statistically significant differences when compared with mild AS in ST–T wave depression during exercise, LVH on resting electrocardiogram, and echocardiogram. There was a significant difference in delta SBP between severe AS and normal controls (delta SBP 21.6 vs. 46.2 mmHg), and between moderate AS and normal controls (delta SBP 32 vs. 46.2 mmHg). There were no significant complications during maximal exercise testing. Children with echocardiographic severe and moderate AS have exercise testing abnormalities. Exercise test criteria for severity of AS were validated for echocardiographic criteria for AS severity.

Keywords

Echocardiogram Cardiopulmonary exercise testing Aortic stenosis Ischemia 

Notes

Compliance with Ethical Standards

Conflict of interest

Stephanie Santana declares that she has no conflict of interest. Samuel S. Gidding declares that he has no conflict of interest. Sherlly Xie declares that she has no conflict of interest. Tiancong Jiang declares that she has no conflict of interest. Rami Kharouf declares that he has no conflict of interest. Bradley W. Robinson declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained for the exercise tests. Informed consent for the study was NOT obtained, but identifying data (medical record number, date of birth, etc.) were removed as per our Institutional Review Board guidelines to pass muster.

References

  1. 1.
    Keane JF, Driscoll DJ, Gersony WM, Hayes CJ, Kidd L, O’Fallon WM, Pieroni DR, Wolfe RR, Weidman WH (1993) Second natural history study of congenital heart defects: results of treatment of patients with aortic valvar stenosis. Circulation 87(2 Suppl):I16–I27PubMedGoogle Scholar
  2. 2.
    Maron BJ (2003) Sudden death in young athletes. N Engl J Med 349:1064–1075CrossRefPubMedGoogle Scholar
  3. 3.
    James FW, Schwartz DC, Kaplan S, Spilkin SP (1982) Exercise electrocardiogram, blood pressure, and working capacity in young patients with valvular or discrete subvalvular aortic stenosis. Am J Cardiol 50:769–775CrossRefPubMedGoogle Scholar
  4. 4.
    Alpert BS, Kartodihardjo W, Harp R, Izukawa T, Strong WB (1981) Exercise blood pressure response—a predictor of severity of aortic stenosis in children. J Pediatr 98:763–765CrossRefPubMedGoogle Scholar
  5. 5.
    Chandramouli B, Ehmke DA, Lauer RM (1975) Exercise-induced electrocardiographic changes in children with congenital aortic stenosis. J Pediatr 87:725–730CrossRefPubMedGoogle Scholar
  6. 6.
    Graham TP Jr, Driscoll DJ, Gersony WM, Newburger JW, Rocchini A, Towbin JA (2005) 36th Bethesda Conference: eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities. Task Force 2: congenital heart disease. J Am Coll Cardiol 45:1326–1333CrossRefPubMedGoogle Scholar
  7. 7.
    Mitchell JH, Maron BJ, Epstein SE (1985) 16th Bethesda Conference: Cardiovascular abnormalities in the athlete: recommendations regarding eligibility for competition. October 3–5, 1984. J Am Coll Cardiol 6:1186–1232CrossRefPubMedGoogle Scholar
  8. 8.
    Graham TP Jr, Bricker JT, James FW, Strong WB (1994) 26th Bethesda conference: Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 1: congenital heart disease. J Am Coll Cardiol 24:867–873CrossRefPubMedGoogle Scholar
  9. 9.
    Van Hare GF, Ackerman MJ, Evangelista JK, Kovacs RJ, Myerburg RJ, Shafer KM, Warnes CA, Washington RL, American Heart Association, Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 4: congenital heart disease: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 132:e281–e291.  https://doi.org/10.1161/CIR.0000000000000240 CrossRefPubMedGoogle Scholar
  10. 10.
    Park MK, Guntheroth WG (1987) How to read pediatric ECGs, 2nd edn. Elsevier Health Sciences, ChicagoGoogle Scholar
  11. 11.
    Cumming GR, Everatt D, Hastman L (1978) Bruce treadmill test in children: normal values in a clinic population. Am J Cardiol 41:69–75CrossRefPubMedGoogle Scholar
  12. 12.
    Octavio JM, Folk AL, Falini L, Xie S, Goudie BW, Gidding SS, Robinson BW (2019) Standardization of a continuous ramp ergometer protocol for clinical exercise testing in children. Pediatr Cardiol 40:834–840.  https://doi.org/10.1007/s00246-019-02079-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Whitmer JT, James FW, Kaplan S, Schwartz DC, Knight MJ (1981) Exercise testing in children before and after surgical treatment of aortic stenosis. Circulation 63:254–263CrossRefPubMedGoogle Scholar
  14. 14.
    The R Foundation (2018) ThCoe R project for statistical computing. https://www.r-project.org/. Accessed 7 June 2018.
  15. 15.
    Nishimura RA, Pieroni DR, Bierman FZ, Colan SD, Kaufman S, Sanders SP, Seward JB, Tajik AJ, Wiggins JW, Zahka KG (1993) Second natural history study of congenital heart defects. Aortic stenosis: echocardiography. Circulation 87(2 Suppl):I66–I72PubMedGoogle Scholar
  16. 16.
    Maron BJ, Zipes DP, Kovacs RJ, American Heart Association, Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: preamble, principles, and general considerations: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 132:e256–e261.  https://doi.org/10.1161/CIR.0000000000000236 CrossRefPubMedGoogle Scholar
  17. 17.
    Brown DW, Dipilato AE, Chong EC, Gauvreau K, McElhinney DB, Colan SD, Lock JE (2010) Sudden unexpected death after balloon valvuloplasty for congenital aortic stenosis. J Am Coll Cardiol 56:1939–1946.  https://doi.org/10.1016/j.jacc.2010.06.048 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Nemours Cardiac CenterNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Familial Hypercholesterolemia FoundationPasadenaUSA
  3. 3.Nemours/Alfred I. duPont Hospital for ChildrenNemours Biomedical ResearchWilmingtonUSA
  4. 4.Drexel UniversityPhiladelphiaUSA
  5. 5.Department of PediatricsSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaUSA
  6. 6.Division of Pediatric CardiologyMedical University of South CarolinaCharlestonUSA

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