title: Supine exercise echocardiographic measures of systolic and diastolic function in children.
abstract: BACKGROUND
  Echocardiography has been used to determine ventricular function, segmental wall motion abnormality, and pulmonary artery pressure before and after peak exercise. No prior study has investigated systolic and diastolic function using echocardiography at various phases of exercise in children. The aim of this study was to determine the fractional shortening (FS), systolic-to-diastolic (S/D) ratio, heart rate-corrected velocity of circumferential fiber shortening (VCFc), circumferential wall stress (WS), ratio of mitral passive inflow to active inflow (E/A), ratio of passive inflow by pulsed-wave to tissue Doppler (E/E'), and right ventricular-to-right atrial pressure gradient from tricuspid valve regurgitation jet velocity (RVP) and time duration at various phases of exercise in children.
  
  
  METHODS
  In an 8-month period (December 2007 to July 2008), 100 healthy children were evaluated, and 97 participants aged 8 to 17 years who performed complete cardiopulmonary exercise stress tests using supine cycle ergometry were prospectively enrolled. The participants consisted of 48 female and 49 male subjects with various body sizes, levels of exercise experience, and physical capacities. The cardiopulmonary exercise stress test consisted of baseline pulmonary function testing, continuous gas analysis and monitoring of blood pressure and heart rate responses, electrocardiographic recordings, and oxygen saturation measurement among participants who pedaled against a ramp protocol based on body weight. All participants exercised to exhaustion. Echocardiography was performed during exercise at baseline, at a heart rate of 130 beats/min, at a heart rate of 160 beats/min, at 5 min after exercise, and at 10 min after exercise. FS, S/D ratio, VCFc, WS, E/A, E', E/E', and RVP at these five phases were compared in all subjects.
  
  
  RESULTS
  All echocardiographic parameters differed at baseline from 160 beats/min (P < .0001) except E/E', which remained at 5.4 to 5.8. Specifically, FS (from 37% to 46%), S/D ratio, VCFc (from 1.1 to 1.6), WS (from 200 to 258 g/cm(2)), E' (from 0.2 to 0.3), and RVP (from 18 to 35 mm Hg) increased from baseline to 160 beats/min and then subsequently decreased to at or near baseline, while tricuspid valve regurgitation duration decreased (from 370 to 178 msec).
  
  
  CONCLUSIONS
  Normal values for systolic and diastolic echocardiographic measurements of function are now available. FS, VCFc, WS, and RVP increase with exercise and then return to near baseline levels. The E/E' ratio is unaltered with exercise in normal subjects.
authors.affiliation: Lucile Packard Children's Hospital, Palo Alto, California 94304, USA. rpunn@stanford.edu
authors.forename: Rajesh
authors.initials: R
authors.lastname: Punn
authors.forename: Derek Y
authors.initials: DY
authors.lastname: Obayashi
authors.forename: Inger
authors.initials: I
authors.lastname: Olson
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kazmucha
authors.forename: Anne
authors.initials: A
authors.lastname: DePucci
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hurley
authors.forename: Clifford
authors.initials: C
authors.lastname: Chin
mesh_terms: D000293:Adolescent; D002648:Child; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D016683:Supine Position / Q000502:physiology*; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*