title: 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.
authors.affiliation: Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
authors.forename: P
authors.initials: P
authors.lastname: Ciliberti
authors.forename: I
authors.initials: I
authors.lastname: McLeod
authors.forename: F
authors.initials: F
authors.lastname: Cairello
authors.forename: J P
authors.initials: JP
authors.lastname: Kaski
authors.forename: M
authors.initials: M
authors.lastname: Fenton
authors.forename: A
authors.initials: A
authors.lastname: Giardini
authors.forename: J
authors.initials: J
authors.lastname: Marek
mesh_terms: D000293:Adolescent; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology; D002648:Child; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006321:Heart / Q000033:anatomy & histology* / Q000502:physiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D018570:Risk Assessment; D016683:Supine Position; D016277:Ventricular Function, Left / Q000502:physiology