Feasibility of Noninvasive Diastolic Stress Testing in the 10- to 21-Year-Old Age Group
A subset of adult patients with heart failure symptoms and normal left ventricular systolic function have primary left ventricular diastolic dysfunction with elevated filling pressure. Noninvasive diastolic stress testing (NDST) has been used in adults to reveal left ventricular diastolic dysfunction during exercise. Given limited data in young individuals, we assessed the feasibility and reliability of NDST in a diverse sample of 10- to 21-year-olds. Twenty-two participants with a normal cardiac evaluation from our Le Bonheur Children’s Hospital Heart Institute outpatient center were recruited for the study protocol. After consent and screening, 1 study participant was ineligible (obesity), leaving 21 patients. Baseline echocardiograms were performed at rest and as part of a graduated exercise stress test at 10, 20, and 30 W using a semirecumbent cycle ergometer. Conventional exercise data, baseline echocardiogram data, and left ventricular diastolic parameters were obtained. Left ventricular diastolic parameters were measured during each exercise stage and at 5- and 10-minute recovery. Two blinded readers (pediatric cardiologists) reviewed the echocardiograms to determine interobserver variability. Mean age and body mass index were 15.3 ± 3 years and 21.2 ± 3.1 kg·m−2, respectively. There was 81% agreement between readers with a Cohen κ coefficient of 0.44 (moderate agreement). The mitral E/e′ remained normal during exercise and recovery. NDST is a feasible and reliable technique in a diverse sample in the 10- to 21-year-old age range.ABSTRACT
Background
Methods
Results
Conclusion
(A) Rendering of a noninvasive diastolic stress test using a semisupine cycle ergometer with a study participant. First author (left), pediatric cardiac sonographer (seated), and clinical exercise physiologist and second author (right) with anonymized participant. (B) Panels include representative echocardiographic data. The mitral E/e′ ratio is listed below baseline, exercise, and recovery. The mitral inflow peak velocity increases during exercise (note scale change from baseline to 30 W). There is a proportional increase in the mitral peak E velocity and mitral medial annulus e′ velocity so that the mitral E/e′ ratio remains normal during exercise and 5-minute recovery.
aTen-minute recovery is not shown. TDI = tissue Doppler imaging.
Contributor Notes
Conflicts of Interest: No conflicts of interest.
Sources of Funding: This work was supported by the Le Bonheur Children’s Hospital Foundation and the St. Jude Pediatric Research Recruitment Support Fund (R079700270).