title: Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension.
abstract: BACKGROUND
  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 O2 saturation.
  
  
  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 O2 saturation >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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1North Central Thames Foundation School,London,United Kingdom.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Abumehdi
authors.affiliation: 2North West Thames Foundation School,London,United Kingdom.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0003-1082-2764
authors.initials: AJ
authors.lastname: Wardle
authors.affiliation: 3Cardiorespiratory Unit,Great Ormond Street Hospital,London,United Kingdom.
authors.forename: Rewa
authors.initials: R
authors.lastname: Nazzal
authors.affiliation: 3Cardiorespiratory Unit,Great Ormond Street Hospital,London,United Kingdom.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Charalampopoulos
authors.affiliation: 3Cardiorespiratory Unit,Great Ormond Street Hospital,London,United Kingdom.
authors.forename: Ingram
authors.initials: I
authors.lastname: Schulze-Neick
authors.affiliation: 3Cardiorespiratory Unit,Great Ormond Street Hospital,London,United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Derrick
authors.affiliation: 3Cardiorespiratory Unit,Great Ormond Street Hospital,London,United Kingdom.
authors.forename: Shahin
authors.initials: S
authors.lastname: Moledina
authors.affiliation: 3Cardiorespiratory Unit,Great Ormond Street Hospital,London,United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giardini
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D005080:Exercise Test / Q000009:adverse effects; D017079:Exercise Tolerance; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male
chemical_list: D000925:Anticoagulants
keywords: CHDs; Pulmonary hypertension; exercise physiology; exercise test