Key result
Expert survey and review summarize serial exercise stress testing practices in pediatric heart disease.
Why the study?
Established guidelines exist for serial exercise stress testing in adults with congenital heart disease, but corollary guidelines do not exist for the pediatric population.
What are the current practices and evidence for serial exercise testing in children with congenital and acquired heart disease?
What are the current practices and evidence for serial exercise testing in children with congenital and acquired heart disease?
This narrative review and survey highlights the current practices and lack of established guidelines for serial exercise stress testing in pediatric patients with congenital and acquired heart disease, suggesting the need for multicenter registries.
Variable practices persist without guidelines; leaves open standardization via multicenter registries in pediatric heart disease.
BACKGROUND: Exercise parameters can be altered in children with congenital heart disease or acquired heart disease compared with children with normal hearts. Exercise testing has proven a useful tool to predict patient outcomes and even the need for reintervention in several cardiovascular disease processes. There are established guidelines for serial exercise stress testing in adults with congenital heart disease, but corollary guidelines do not exist for the pediatric population. METHODS AND RESULTS: A narrative literature review was completed. Evidence was ranked by a 4-point scale as outlined by the American College of Sports Medicine evidence categories. A survey was sent to experts in pediatric exercise physiology across the country regarding their current testing practices for 26 unique congenital heart disease or known or suspected acquired heart disease lesions. Survey questions were related to the frequency of testing, the age at which exercise testing is started, and if the frequency of testing is altered by a patient presenting with symptoms. Our literature search yielded 122 relevant studies pertaining to exercise stress testing in pediatric heart disease. We received 59 responses to our survey from 33 unique institutions in the United States and Canada. CONCLUSIONS: Twenty-one summaries were provided regarding exercise stress testing in pediatric patients with heart disease. Multicentered or national stress testing registries may allow for adequate sample sizes of rare pediatric diseases to allow for development of improved guidelines regarding the type and timing of stress testing.
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Hollon et al. (2025) conducted a review in Congenital and acquired heart disease (n=59). Serial exercise testing was evaluated on Current testing practices including frequency and starting age. Serial exercise stress testing practices in children with heart disease were summarized based on a narrative review of 122 studies and a survey of 59 experts across 33 institutions.
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