Symptomatic Exercise-induced Intraventricular Gradient in Competitive
            Athlete

Dores, Hélder; Mendes, Lígia; Ferreira, Alexandre Oliveira; Santos, José Ferreira

doi:10.5935/abc.20170075

Cited by 1 publication

(2 citation statements)

References 12 publications

(15 reference statements)

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“…We looked for usual details, like RWMAs to exclude coronary disease, valvular gradients, and intraventricular gradients in HCM children; however, the evaluation of intraventricular gradients is also performed in other children by routine, including those with a normal echocardiogram. The detection of exercise-induced intraventricular gradients (IVGs) related to symptoms such as angina, tiredness, or syncope in patients with normal echocardiogram (no hypertrophy) has previously been published [1,16,[40][41][42][43][44][45][46]. The association of IVGs with symptoms [1,23,24,45,46] in terms of pediatric age has been previously demonstrated, and our results, where a significant orthostatic exercise-induced IVG appeared, seem to confirm this association.…”

Section: Discussionsupporting

confidence: 86%

“…The presence of IVG was considered a normal finding by only one group of investigators [40]. The results of the present study and those from other authors suggest a clear relation between IVG and symptoms [16,[40][41][42][43][44], and the clinical response to beta-blocker treatment [38,39] favors this conclusion. Guidelines recommend the use of stress echocardiography in adults when available as a first-line test instead of an exercise stress test.…”

Section: Discussionsupporting

confidence: 70%

See 1 more Smart Citation

Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population

Cotrim,

Café,

Guardado

et al. 2024

JCM

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Background: 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.

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