Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension
Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension
复制标题
DOI：
10.1017/s1047951115001961
复制
发表时间：
2016-08-01
影响因子：
1
通讯作者：
Giardini, Alessandro
中科院分区：
文献类型：
--
作者：
Abumehdi, Mohammad R.;Wardle, Andrew J.;Giardini, Alessandro
背景：心脏运动试验有助于诊断和指导成人肺动脉高压的治疗。对它的可行性和安全性的担忧限制了它在肺动脉高压儿童中的使用。我们的目的是在一个大型的儿科肺动脉高压队列中评估心肺运动试验的可行性和安全性。方法：我们回顾了2004年3月至2013年11月期间进行的所有连续心肺运动试验。排除标准如下：身高< 120 cm，世界卫生组织IV级，运动诱发晕厥史，或严重缺血/心律失常。记录的重要事件如下：患者报告的症状、心律失常、心电图异常和动脉O-2饱和度的异常反应。结果：共98名儿童进行了167次心肺运动试验。中位年龄为14岁（四分位数间距为10-15岁）。峰值摄氧量为20.4 +/- 7.3 ml/kg/min，相当于预测值的51.8 +/- 18.3%。峰值呼吸商为1.08 +/- 0.16。除两项试验外，所有试验均为最大值试验，因临床原因提前终止。基线血氧饱和度为93.3 +/- 8.8%，运动峰值时为81.2 +/- 19.5%。在23.5%的患者中观察到动脉血氧饱和度下降> 20%。此外，5例患者（3.0%）出现头晕，1例需要终止心肺运动试验; 5例儿童（3.0%）出现胸痛，1例患者提前终止心肺运动试验。未观察到显著心律失常或心电图变化。结论：在非严重症状的肺动脉高压儿童中进行运动试验是安全和实用的，并且可以在有经验的团队的受控环境中在大量肺动脉高压儿童中进行。副作用并不严重，并在试验终止后迅速消退。
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 O-2 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. Conclusion: 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.