Prognostic Value of Exercise Stress Echocardiography in Pediatric Cardiac Transplant Recipients

Pérez, María T.; Rizwan, Raheel; Daly, Kevin P.; Deng, Ellen; Blume, Elizabeth D.; Singh, Tajinder P.; Chen, Ming Hui

doi:10.1016/j.echo.2022.07.006

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…We consider that ESE has the potential to offer the same benefits to the pediatric population; however, it is an underexplored diagnostic tool, perhaps due to concerns regarding the learning curve of the method and its safety and applicability in terms of pediatric age. Given its diagnostic accuracy, ability to assess cardiac function, and lack of radiation, ESE should be considered a first-line diagnostic method, as it is a helpful tool in the clinical assessment of pediatric patients [2][3][4][5][6][7][8][9][10][11][12][13][14]. Physicians need to be aware that, despite the clinical necessity of imaging studies, the associated ionizing radiation exposure could pose an increased lifetime attributable risk of cancer [15].…”

Section: Introduction and Aimsmentioning

confidence: 99%

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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