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Cardiopulmonary exercise testing in congenital heart disease: (contra)indications and interpretation

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Abstract

Cardiopulmonary exercise testing (CPET) in paediatric cardiology differs in many aspects from the tests performed in adult cardiology. Children's cardiovascular responses during exercise testing present different characteristics, particularly oxygen uptake, heart rate and blood pressure response, which are essential in interpreting haemodynamic data. Diseases that are associated with myocardial ischaemia are rare in children. The main indications for CPET in children are evaluation of exercise capacity and the identification of exercise-induced arrhythmias. In this article we will review the main indications for CPET in children with congenital heart disease, the contraindications for exercise testing and the indications for terminating an exercise test. Moreover, we will address the interpretation of gas exchange data from CPET in children with congenital heart disease. (Neth Heart J 2009;17:385–92.)

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References

  1. Connuck DM. The role of exercise stress testing in pediatric patients with heart disease. Pediatr Cardiol. 2005;20:45–52.

    Google Scholar 

  2. Bar-Or O. Pathophysiological factors which limit the exercise capacity of the sick child. Med Sci Sports Exerc. 1986;18:276–82.

    Google Scholar 

  3. Lunt D, Briffa T, Briffa NK, Ramsay J. Physical activity levels of adolescents with congenital heart disease. Aust J Physiother. 2003; 49:43–50.

    Google Scholar 

  4. Rich MW. Heart failure disease management: a critical review. J Card Fail. 1999;5:64–75.

    Google Scholar 

  5. Alpert BS, Verrill DE, Flood NL, Boineau JP, Strong WB. Complications of ergometer exercise in children. Pediatr Cardiol. 1983; 4:91–6.

    Google Scholar 

  6. Stephens P Jr, Paridon SM. Exercise testing in pediatrics. Pediatr Clin North Am. 2004;51:1569–87, viii.

    Google Scholar 

  7. Rodgers GP, Ayanian JZ, Balady G, Beasley JW, Brown KA, Gervino EV, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2000;102:1726–38.

    Google Scholar 

  8. Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:1422–45.

    Google Scholar 

  9. Taylor CB, Bandura A, Ewart CK, Miller NH, DeBusk RF. Exercise testing to enhance wives' confidence in their husbands' cardiac capability soon after clinically uncomplicated acute myocardial infarction. Am J Cardiol. 1985;55:635–8.

    Google Scholar 

  10. Moalla W, Gauthier R, Maingourd Y, Ahmaidi S. Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease. Int J Sports Med. 2005;26:756–62.

    Google Scholar 

  11. Bar-Or O. Pediatric sports medicine for the practitioner. New York: Springer-Verlag; 1983.

  12. Shephard RJ, Allen C, Benade AJ, Davies CT, Di Prampero PE, Hedman R, et al. The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ. 1968;38:757–64.

    Google Scholar 

  13. Hill AV, Lupton H. Muscular exercise, lactic acid and the supply and utilization of oxygen. Q J Med. 1923;16:135–71.

    Google Scholar 

  14. Howley ET, Bassett DRJ, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc. 1995;27: 1292–301.

    Google Scholar 

  15. Rowland TW. Does peak VO2 reflect VO2max in children?: evidence from supramaximal testing. Med Sci Sports Exerc. 1993; 25:689–93.

    Google Scholar 

  16. Armstrong N, Welsman J, Winsley R. Is peak VO2 a maximal index of children's aerobic fitness? Int J Sports Med. 1996;17: 356–9.

    Google Scholar 

  17. Fick A. Ueber die Messung des Blutquantums in den Herzventrikeln. Sitx Physik-Med Ges Wurzburg. 1870;2:16.

  18. Shephard RJ, Allen C, Benade AJ, Davies CT, Di Prampero PE, Hedman R, et al. The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ. 1968;38:757–64.

    Google Scholar 

  19. Haller RG, Lewis SF, Cook JD, Blomqvist CG. Hyperkinetic circulation during exercise in neuromuscular disease. Neurology. 1983;33:1283–7.

    Google Scholar 

  20. Taylor HL, Buskirk E, Henschel A. Maximal oxygen intake as an objective measure of cardiorespiratory performance. J Appl Physiol. 1955;8:73–80.

    Google Scholar 

  21. Franklin BA. Abnormal cardiorespiratory responses to acute aerobic exercise. In: Roitman JL, editor. ACSM's resource manual for guidelines for exercise testing and prescription. Third edition. Baltimore: Williams and Wilkins; 1998. p. 146–55.

  22. Rowland TW. Aerobic exercise testing protocols. In: Rowland TW, editor. Pediatric Laboratory Exercise Testing: Clinical Guidelines. Champaign, Ill: Human Kinetics; 1993. p. 19–41.

  23. Cooper DM, Weiler-Ravell D, Whipp BJ, Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol. 1984;56:628–34.

    Google Scholar 

  24. Astrand PO. Experimental studies of physical work capacity in relation to sex and age: Copenhagen, Munkgaard; 1952.

  25. Owens S, Gutin B. Exercise testing of the child with obesity. Pediatr Cardiol. 1999;20:79–83.

    Google Scholar 

  26. Tanner JM. Fallacy of per weight and per surface area standards and their relation to spurius correlation. J Appl Physiol. 1949;2: 1–15.

    Google Scholar 

  27. Schmidt-Nielsen K. Scaling: Why is animal size so important? Cambridge: Cambridge University Press; 1984.

  28. Weibel ER, Hoppeler H. Exercise-induced maximal metabolic rate scales with muscle aerobic capacity. J Exp Biol. 2005;208: 1635–44.

    Google Scholar 

  29. Hermansen L, Ekblom B, Saltin B. Cardiac output during submaximal and maximal treadmill and bicycle exercise. J Appl Physiol. 1970;29:82–6.

    Google Scholar 

  30. Hermansen L, Saltin B. Oxygen uptake during maximal treadmill and bicycle exercise. J Appl Physiol. 1969;26:31–7.

    Google Scholar 

  31. Astrand P, Rodahl K, Astrand PRK. Textbook of work physiology, physiological bases of exercise. New York: McGraw-Hill Book Company; 1986.

  32. Ohuchi H. Cardiopulmonary response to exercise in patients with the Fontan Circulation. Cardiol Young. 2005;15 Suppl 3:39–44.

    Google Scholar 

  33. McManus A, Leung M. Maximising the clinical use of exercise gaseous exchange testing in children with repaired cyanotic congenital heart defects: the development of an appropriate test strategy. Sports Med. 2000;29:229–44.

    Google Scholar 

  34. Singh TP, Rhodes J, Gauvreau K. Determinants of heart rate recovery following exercise in children. Med Sci Sports Exerc. 2008;40:601–5.

    Google Scholar 

  35. Singh TP, Curran TJ, Rhodes J. Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol. 2007;28:276–9.

    Google Scholar 

  36. Godfrey S. Exercise testing in children. London: W.B. Saunders Company Ltd.; 1974.

  37. Driscoll DJ, Staats BA, Beck KC. Measurement of Cardiac Output in Children During Exercise: A Review. Pediatr Exerc Sci. 1989;1: 102–15.

    Google Scholar 

  38. Baba R, Nagashima M, Nagano Y, Ikoma M, Nishibata K. Role of the oxygen uptake efficiency slope in evaluating exercise tolerance. Arch Dis Child. 1999;81:73–5.

    Google Scholar 

  39. Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996;28:1567–72.

    Google Scholar 

  40. Marinov B, Mandadzhieva S, Kostianev S. Oxygen-uptake efficiency slope in healthy 7- to 18-year-old children. Pediatr Exerc Sci. 2007;19:159–70.

    Google Scholar 

  41. Groen WG, Hulzebos EH, Helders PJ, Takken, T. Oxygen Uptake To Work Rate Relationship During Exercise In Children With Lung, Heart or Muscle Disease. Med Sci Sports Exerc. 2009;41:S5, Abstract 1658.

  42. Hansen JE, Sue DY, Oren A, Wasserman K. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders. Am J Cardiol. 1987;59:669–74.

    Google Scholar 

  43. Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of Exercise Testing and Interpretation. Baltimore, MD: Lippincott, Williams and Wilkins; 1999.

  44. Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM. Excessive anaerobic metabolism during exercise after repair of aortic coarctation. J Pediatr. 1997;131:210–4.

    Google Scholar 

  45. Eschenbacher WL, Mannina A. An algorithm for the interpretation of cardiopulmonary exercise tests. Chest. 1990;97:263–7.

    Google Scholar 

  46. Riopel DA, Taylor AB, Hohn AR. Blood pressure, heart rate, pressure-rate product and electrocardiographic changes in healthy children during treadmill exercise. Am J Cardiol. 1979;44:697–704.

    Google Scholar 

  47. Rowell LB, O'Leary DS. Reflex control of the circulation during exercise: chemoreflexes and mechanoreflexes. J Appl Physiol. 1990; 69:407–18.

    Google Scholar 

  48. Turley KR, Wilmore JH. Cardiovascular responses to treadmill and cycle ergometer exercise in children and adults. J Appl Physiol. 1997;83:948–57.

    Google Scholar 

  49. Reybrouck T, Rogers R, Weymans M, Dumoulin M, Vanhove M, Daenen W, et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr. 1995;154:801–6.

    Google Scholar 

  50. De Groot JF, Takken T, Schoenmakers MA, Vanhees L, Helders PJ. Limiting factors in peak oxygen uptake and the relationship with functional ambulation in ambulating children with Spina Bifida. Eur J Appl Physiol. 2008;104:657–65.

    Google Scholar 

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    T. Takken

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  1. T. Takken
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  2. A. C. Blank
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  3. E. H. Hulzebos
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  4. M. van Brussel
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  5. W. G. Groen
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  6. P. J. Helders
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Correspondence to T. Takken.

Additional information

Child development exercise center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands.

Department of Paediatric Cardiology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands

T. Takken Department of Paediatric Physical Therapy & Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KB02.056.0, PO Box 85090, 3508 AB Utrecht, the Netherlands

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Takken, T., Blank, A.C., Hulzebos, E.H. et al. Cardiopulmonary exercise testing in congenital heart disease: (contra)indications and interpretation. NHJL 17, 385–392 (2009). https://doi.org/10.1007/BF03086289

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