Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension

Abumehdi, Mohammad R.; Wardle,
Andrew J.; Nazzal, Rewa; Charalampopoulos, Athanasios; Schulze-Neick,
Ingram; Derrick, Graham; Moledina, Shahin; Giardini, Alessandro.
Cardiology in the Young, August 2016, Vol. 26 Issue: Number 6
p1144-1150, 7p;


AbstractBackground   Cardiopulmonary exercise
testing helps prognosticate and guide treatment in adults with
pulmonary hypertension. Concerns regarding its feasibility and safety
limit its use in children with pulmonary hypertension. We aimed to
assess the feasibility and safety of cardiopulmonary exercise testing
in a large paediatric pulmonary hypertension cohort.

Methods  We reviewed
all consecutive cardiopulmonary exercise tests performed between March,
2004 and November, 2013. The exclusion criteria were as follows: height
<120 cm, World Health Organization class IV, history of
exercise-induced syncope, or significant ischaemia/arrhythmias.
Significant events recorded were as follows: patient-reported symptoms,
arrhythmias, electrocardiogram abnormalities, and abnormal responses of
arterial O2saturation.

Results  A total of 98 children underwent 167
cardiopulmonary exercise tests. The median age was 14 years
(inter-quartile range 10–15 years). Peak oxygen uptake was 20.4±7.3
ml/kg/minute, corresponding to 51.8±18.3% of the predicted value. Peak
respiratory quotient was 1.08±0.16. All the tests except two were
maximal, being terminated prematurely for clinical reasons. Baseline
Oxygen saturation was 93.3±8.8% and was 81.2±19.5% at peak exercise. A
drop in arterial O2saturation >20% was observed in 23.5% of the
patients. Moreover, five patients (3.0%) experienced dizziness, one
requiring termination of cardiopulmonary exercise testing; five
children (3.0%) experienced chest pain, with early cardiopulmonary
exercise test termination in one patient. No significant arrhythmias or
electrocardiogram changes were observed.

Conclusion  Exercise testing in
non-severely symptomatic children with pulmonary hypertension is safe
and practical, and can be performed in a large number of children with
pulmonary hypertension in a controlled environment with an experienced
team. Side-effects were not serious and were resolved promptly with
test termination.