A Systematic Review of Reference Values in Pediatric Cardiopulmonary Exercise Testing

Blais, Samuel; Berbari, Jade; Counil,
Francois-Pierre; Dallaire, Frederic.

Pediatric Cardiology, December
2015, Vol. 36 Issue: Number 8 p1553-1564, 12p;

Cardiopulmonary exercise testing (CPET) is used for the diagnosis and
prognosis of cardiovascular and pulmonary conditions in children and
adolescents. Several authors have published reference values for
pediatric CPET, but evaluation of their validity is lacking. The aim of
this study was to review pediatric CPET references values published
between 1980 and 2014. We specifically assessed the adequacy of the
normalization methods used to adjust for body size. Articles that
proposed references values were reviewed. We abstracted information on
exercise protocols, CPET measurements and normalization methods. We
then evaluated the studies’ methodological quality and assessed them
for potential biases. Thirty-four studies were included. We found
important heterogeneity in the choice of exercise protocols and in the
approach to adjustment for body size or other relevant confounding
factors. Adjustment for body size was principally done using linear
regression for age or weight. Assessment of potential biases (residual
association, heteroscedasticity and departure from the normal
distribution) was mentioned in only a minority of studies. Our study
shows that contemporary pediatric reference values for CPET have been
developed based on heterogeneous exercise protocols and variable
normalization strategies. Furthermore, assessment of potential bias has
been inconsistent and insufficiently described. High-quality reference
values with adequate adjustment for confounding variables are needed in
order to optimize CPET’s specificity and sensitivity to detect abnormal
cardiopulmonary response to exercise.