Reference values for blood pressure response to cycle ergometry in the first two decades of life: comparison with patients with a repaired coarctation of the aorta

Kaafarani, Mirna; Schroer, Christian; Takken, Tim

doi:10.1080/14779072.2017.1385392

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…Over two-thirds (68%) of CoA patients were hypertensive during exercise. This finding is in line with a recent study in children and adolescents after CoA repair [25]. Exercise hypertension is a strong predicator for systemic hypertension and cardiovascular events in long-term follow-up [2, 7].…”

Section: Discussionsupporting

confidence: 89%

Exercise Capacity in Asymptomatic Adult Patients Treated for Coarctation of the Aorta

et al. 2019

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A reduced exercise capacity is a common finding in adult congenital heart disease and is associated with cardiovascular morbidity and mortality. However, data on exercise capacity in patients after repair of coarctation of the aorta (CoA) are scarce. Furthermore, a high rate of exercise-induced hypertension has been described in CoA patients. This study sought to assess exercise capacity and blood pressure response in asymptomatic patients long-term after CoA repair in relation to left ventricular and vascular function. Twenty-two CoA patients (age 30 ± 10.6 years) with successful surgical repair (n = 12) or balloon angioplasty (n = 10) between 3 months and 16 years of age with a follow-up of > 10 years underwent cardiopulmonary exercise testing at a mean follow-up of 23.9 years. Exercise capacity (peak oxygen uptake; VO2peak) and blood pressure response were compared to age- and gender-matched reference values. Left ventricular function and volumetric analysis was performed using cardiovascular magnetic resonance imaging. CoA patients showed preserved exercise capacity compared to the healthy reference group, with a VO2peak of 41.7 ± 12.0 ml/kg/min versus 44.9 ± 6.7 ml/kg/min. VO2peak/kg showed a significant association with age (p < 0.001) and male gender (p ≤ 0.001). Exercise-induced hypertension occurred in 82% of CoA patients, and was strongly related to left ventricular mass (p = 0.04). Of the 41% of patients who were normotensive at rest, 78% showed exercise-induced hypertension. No significant correlation was found between peak exercise blood pressure and age, BMI, age at time of repair, LVEF, or LV dimensions. Exercise capacity is well preserved in patients long-term after successful repair of coarctation of the aorta. Nevertheless, a high number of patients develop exercise hypertension, which is strongly related to systemic hypertension. Regular follow-up, including cardiopulmonary exercise testing, and aggressive treatment of hypertension after CoA repair is strongly advised.

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Section: Discussionsupporting

confidence: 89%

Exercise Capacity in Asymptomatic Adult Patients Treated for Coarctation of the Aorta

et al. 2019

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“…One study [31] performed in children provided two prediction equations for systolic blood pressure at peak exercise. Systolic blood pressure increased with attained work rate at peak exercise (WR peak ), and the increment in systolic blood pressure was independent of age and sex.…”

Section: Blood Pressurementioning

confidence: 99%

Reference values for cardiopulmonary exercise testing in healthy subjects – an updated systematic review

Takken

Mylius

Paap

et al. 2019

Expert Review of Cardiovascular Therapy

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Introduction: Reference values for cardiopulmonary exercise testing (CPET) parameters provide the comparative basis for answering important questions concerning the normalcy of exercise responses in patients, and significantly impacts the clinical decision-making process. Areas covered: The aim of this study was to provide an updated systematic review of the literature on reference values for CPET parameters in healthy subjects across the life span. A systematic search in MEDLINE, Embase, and PEDro databases were performed for articles describing reference values for CPET published between March 2014 and February 2019. Expert opinion: Compared to the review published in 2014, more data have been published in the last five years compared to the 35 years before. However, there is still a lot of progress to be made. Quality can be further improved by performing a power analysis, a good quality assurance of equipment and methodologies, and by validating the developed reference equation in an independent (sub)sample. Methodological quality of future studies can be further improved by measuring and reporting the level of physical activity, by reporting values for different racial groups within a cohort as well as by the exclusion of smokers in the sample studied. Normal reference ranges should be well defined in consensus statements.

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“…Blood pressure response during progressive exercise is also an important circulatory parameter. Systolic blood pressure should increase with exercise intensity (~30 mm Hg/100 W), with a marked increase above the VAT (23). Although it is difficult to obtain valid measurements of diastolic blood pressure during exercise, this value should remain stable.…”

Section: : Determining Physiological Limitationsmentioning

confidence: 99%

A Systematic Approach to Interpreting the Cardiopulmonary Exercise Test in Pediatrics

Brussel

Bongers

Hulzebos

et al. 2019

Pediatric Exercise Science

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The use of cardiopulmonary exercise testing in pediatrics provides critical insights into potential physiological causes of unexplained exercise-related complaints or symptoms, as well as specific pathophysiological patterns based on physiological responses or abnormalities. Clinical interpretation of the results of a cardiopulmonary exercise test in pediatrics requires specific knowledge with regard to pathophysiological responses and interpretative strategies that can be adapted to address concerns specific to the child's medical condition or disability. In this review, the authors outline the 7-step interpretative approach that they apply in their outpatient clinic for diagnostic, prognostic, and evaluative purposes. This approach allows the pediatric clinician to interpret cardiopulmonary exercise testing results in a systematic order to support their physiological reasoning and clinical decision making.

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Reference values for blood pressure response to cycle ergometry in the first two decades of life: comparison with patients with a repaired coarctation of the aorta

Cited by 10 publications

References 27 publications

Exercise Capacity in Asymptomatic Adult Patients Treated for Coarctation of the Aorta

Exercise Capacity in Asymptomatic Adult Patients Treated for Coarctation of the Aorta

Reference values for cardiopulmonary exercise testing in healthy subjects – an updated systematic review

A Systematic Approach to Interpreting the Cardiopulmonary Exercise Test in Pediatrics

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