title: Assessing ST Segment Changes and Ischemia During Exercise Stress Testing in Patients with Hypoplastic Left Heart Syndrome and Fontan Palliation.
abstract: While exercise stress testing (EST) is an important tool, little is known about its use for determining ischemia in patients with hypoplastic left heart syndrome (HLHS) and Fontan palliation. We sought to determine the frequency of ST segment changes during EST in HLHS patients after Fontan and examine results of further testing performed in response to ST changes. A single-center chart review of HLHS patients post-Fontan from January 1995 to December 2012 was performed. Data collected included demographics, indications for EST, resting electrocardiogram findings, EST and echocardiogram results and outcomes. ESTs were evaluated for ST segment changes concerning for ischemia. Results of additional testing performed based on concerning EST findings were collected. Twenty-seven patients underwent 64 ESTs (mean 2.4 ESTs/patient). Median age at first EST was 9.6 years (range 6.2-16.4). EST was concerning for ischemia in 13 patients (48 %) on 25 (39 %) ESTs. Based on EST results, two patients had stress sestamibi testing, two underwent coronary angiography, and one had both. No reversible perfusion defects or coronary artery obstructions were demonstrated. No patient who underwent EST has died. ST segment depression was not associated with ventricular dysfunction prior to EST or at the end of follow-up (p > 0.05). In patients with HLHS post-Fontan palliation, ST segment depression on EST is common. In patients who underwent further testing, no evidence of ischemia or coronary abnormalities was found. Additional testing may not be necessary in all patients.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX, 77030, USA.
authors.forename: William Buck
authors.initials: WB
authors.lastname: Kyle
authors.affiliation: Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX, 77030, USA.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Denfield
authors.affiliation: Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX, 77030, USA.
authors.forename: Santiago O
authors.initials: SO
authors.lastname: Valdes
authors.affiliation: Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX, 77030, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Penny
authors.affiliation: Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX, 77030, USA.|Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas Medical School, Little Rock, AR, USA.
authors.forename: Elijah H
authors.initials: EH
authors.lastname: Bolin
authors.affiliation: Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin, MC# 19345-C, Houston, TX, 77030, USA. knlopez@bcm.edu.
authors.forename: Keila N
authors.initials: KN
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D002648:Child; D017023:Coronary Angiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006776:Hospitals, Pediatric; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D013781:Texas
keywords: Congenital heart disease; Exercise stress testing; Fontan; Hypoplastic left heart syndrome; Ischemia; ST segment abnormality