Key result
Bicycle exercise stress echocardiography achieves 100% completion without significant arrhythmias or exercise-induced ischemia.
Observational (n=42)
No
Semi-supine bicycle exercise stress echocardiography is a feasible, safe, and reproducible imaging modality for evaluating myocardial structure and function in pediatric patients.
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Supports pediatric ESE feasibility; leaves open prospective validation before clinical adoption.
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.
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Ciliberti et al. (2014) conducted an observational in exercise stress echocardiography in children and adolescents (n=42). Bicycle exercise stress echocardiography vs. No treatment / standard care was evaluated on Successful completion of exercise stress echocardiography. Bicycle exercise stress echocardiography was successfully performed in 100% of patients without any significant arrhythmias or exercise-induced ischemia, showing a peak heart rate of 153 ± 19 bpm during testing.
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