Semi-supine Exercise Stress Echocardiography in Children and Adolescents: Feasibility and Safety

Abstract

Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the feasibility, the safety and the reproducibility of ESE, using on-line scanning in semi-supine cyclo-ergometer protocol in a large pediatric population. Between July 2008 and January 2013, 42 patients (mean age 14 ± 3) were evaluated with a bicycle ESE performing 50 studies. ESE was successfully performed and well tolerated by all patients. None of the patients presented with adverse effects of stress-induced ischemia. HR was 82 ± 13 at rest, and 153 ± 19.1 during peak exercise. Among 544 views analyzed for grading of image quality, the visualization was optimal in 473 (87 %), suboptimal in 39, and inadequate in 32 (6 %). 37 tests were performed in patients with congenital or acquired coronary abnormality. Regional wall motion abnormalities (RWMA) were revealed in nine cases (24 %). The agreement between the two different observers showed a K index of 0.7276 (95 % CI 0.6497–0.8055) for the image quality and a K index of 0.5125 (95 % CI 0.4782–0.5468) for the RWMA analysis. Among ten patients with hypertrophic cardiomyopathy, we were able to demonstrate the new comparison of significant left ventricular outflow tract gradient (≥30 mmHg) during exercise in three patients (30 %). Bicycle stress echocardiography performed by on-line scanning during exercise is a feasible, safe, and reproducible modality in children. Further data to assess its diagnostic accuracy are, however, needed. Stress echocardiography provides a dynamic assessment of the myocardial structure and function under conditions of physiologic or pharmacologic stress.

Clinical Application of Exercise Stress Echocardiography in an Outpatient Pediatric Population

“…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].…”