Skip to main content
Top
Gepubliceerd in: Netherlands Heart Journal 10/2009

01-10-2009 | Review article

Cardiopulmonary exercise testing in congenital heart disease: (contra)indications and interpretation

Auteurs: T. Takken, A. C. Blank, E. H. Hulzebos, M. van Brussel, W. G. Groen, P. J. Helders

Gepubliceerd in: Netherlands Heart Journal | Uitgave 10/2009

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Cardiopulmonary exercise testing (CPET) in paediatric cardiology differs in many aspects from the tests performed in adult cardiology. Children's cardiovascular responses during exercise testing present different characteristics, particularly oxygen uptake, heart rate and blood pressure response, which are essential in interpreting haemodynamic data. Diseases that are associated with myocardial ischaemia are rare in children. The main indications for CPET in children are evaluation of exercise capacity and the identification of exercise-induced arrhythmias. In this article we will review the main indications for CPET in children with congenital heart disease, the contraindications for exercise testing and the indications for terminating an exercise test. Moreover, we will address the interpretation of gas exchange data from CPET in children with congenital heart disease. (Neth Heart J 2009;17:385–92.)
Literatuur
1.
go back to reference Connuck DM. The role of exercise stress testing in pediatric patients with heart disease. Pediatr Cardiol. 2005;20:45–52. Connuck DM. The role of exercise stress testing in pediatric patients with heart disease. Pediatr Cardiol. 2005;20:45–52.
2.
go back to reference Bar-Or O. Pathophysiological factors which limit the exercise capacity of the sick child. Med Sci Sports Exerc. 1986;18:276–82. Bar-Or O. Pathophysiological factors which limit the exercise capacity of the sick child. Med Sci Sports Exerc. 1986;18:276–82.
3.
go back to reference Lunt D, Briffa T, Briffa NK, Ramsay J. Physical activity levels of adolescents with congenital heart disease. Aust J Physiother. 2003; 49:43–50. Lunt D, Briffa T, Briffa NK, Ramsay J. Physical activity levels of adolescents with congenital heart disease. Aust J Physiother. 2003; 49:43–50.
4.
go back to reference Rich MW. Heart failure disease management: a critical review. J Card Fail. 1999;5:64–75. Rich MW. Heart failure disease management: a critical review. J Card Fail. 1999;5:64–75.
5.
go back to reference Alpert BS, Verrill DE, Flood NL, Boineau JP, Strong WB. Complications of ergometer exercise in children. Pediatr Cardiol. 1983; 4:91–6. Alpert BS, Verrill DE, Flood NL, Boineau JP, Strong WB. Complications of ergometer exercise in children. Pediatr Cardiol. 1983; 4:91–6.
6.
go back to reference Stephens P Jr, Paridon SM. Exercise testing in pediatrics. Pediatr Clin North Am. 2004;51:1569–87, viii. Stephens P Jr, Paridon SM. Exercise testing in pediatrics. Pediatr Clin North Am. 2004;51:1569–87, viii.
7.
go back to reference Rodgers GP, Ayanian JZ, Balady G, Beasley JW, Brown KA, Gervino EV, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2000;102:1726–38. Rodgers GP, Ayanian JZ, Balady G, Beasley JW, Brown KA, Gervino EV, et al. American College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. A Report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2000;102:1726–38.
8.
go back to reference Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:1422–45. Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:1422–45.
9.
go back to reference Taylor CB, Bandura A, Ewart CK, Miller NH, DeBusk RF. Exercise testing to enhance wives' confidence in their husbands' cardiac capability soon after clinically uncomplicated acute myocardial infarction. Am J Cardiol. 1985;55:635–8. Taylor CB, Bandura A, Ewart CK, Miller NH, DeBusk RF. Exercise testing to enhance wives' confidence in their husbands' cardiac capability soon after clinically uncomplicated acute myocardial infarction. Am J Cardiol. 1985;55:635–8.
10.
go back to reference Moalla W, Gauthier R, Maingourd Y, Ahmaidi S. Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease. Int J Sports Med. 2005;26:756–62. Moalla W, Gauthier R, Maingourd Y, Ahmaidi S. Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease. Int J Sports Med. 2005;26:756–62.
11.
go back to reference Bar-Or O. Pediatric sports medicine for the practitioner. New York: Springer-Verlag; 1983. Bar-Or O. Pediatric sports medicine for the practitioner. New York: Springer-Verlag; 1983.
12.
go back to reference Shephard RJ, Allen C, Benade AJ, Davies CT, Di Prampero PE, Hedman R, et al. The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ. 1968;38:757–64. Shephard RJ, Allen C, Benade AJ, Davies CT, Di Prampero PE, Hedman R, et al. The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ. 1968;38:757–64.
13.
go back to reference Hill AV, Lupton H. Muscular exercise, lactic acid and the supply and utilization of oxygen. Q J Med. 1923;16:135–71. Hill AV, Lupton H. Muscular exercise, lactic acid and the supply and utilization of oxygen. Q J Med. 1923;16:135–71.
14.
go back to reference Howley ET, Bassett DRJ, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc. 1995;27: 1292–301. Howley ET, Bassett DRJ, Welch HG. Criteria for maximal oxygen uptake: review and commentary. Med Sci Sports Exerc. 1995;27: 1292–301.
15.
go back to reference Rowland TW. Does peak VO2 reflect VO2max in children?: evidence from supramaximal testing. Med Sci Sports Exerc. 1993; 25:689–93. Rowland TW. Does peak VO2 reflect VO2max in children?: evidence from supramaximal testing. Med Sci Sports Exerc. 1993; 25:689–93.
16.
go back to reference Armstrong N, Welsman J, Winsley R. Is peak VO2 a maximal index of children's aerobic fitness? Int J Sports Med. 1996;17: 356–9. Armstrong N, Welsman J, Winsley R. Is peak VO2 a maximal index of children's aerobic fitness? Int J Sports Med. 1996;17: 356–9.
17.
go back to reference Fick A. Ueber die Messung des Blutquantums in den Herzventrikeln. Sitx Physik-Med Ges Wurzburg. 1870;2:16. Fick A. Ueber die Messung des Blutquantums in den Herzventrikeln. Sitx Physik-Med Ges Wurzburg. 1870;2:16.
18.
go back to reference Shephard RJ, Allen C, Benade AJ, Davies CT, Di Prampero PE, Hedman R, et al. The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ. 1968;38:757–64. Shephard RJ, Allen C, Benade AJ, Davies CT, Di Prampero PE, Hedman R, et al. The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ. 1968;38:757–64.
19.
go back to reference Haller RG, Lewis SF, Cook JD, Blomqvist CG. Hyperkinetic circulation during exercise in neuromuscular disease. Neurology. 1983;33:1283–7. Haller RG, Lewis SF, Cook JD, Blomqvist CG. Hyperkinetic circulation during exercise in neuromuscular disease. Neurology. 1983;33:1283–7.
20.
go back to reference Taylor HL, Buskirk E, Henschel A. Maximal oxygen intake as an objective measure of cardiorespiratory performance. J Appl Physiol. 1955;8:73–80. Taylor HL, Buskirk E, Henschel A. Maximal oxygen intake as an objective measure of cardiorespiratory performance. J Appl Physiol. 1955;8:73–80.
21.
go back to reference Franklin BA. Abnormal cardiorespiratory responses to acute aerobic exercise. In: Roitman JL, editor. ACSM's resource manual for guidelines for exercise testing and prescription. Third edition. Baltimore: Williams and Wilkins; 1998. p. 146–55. Franklin BA. Abnormal cardiorespiratory responses to acute aerobic exercise. In: Roitman JL, editor. ACSM's resource manual for guidelines for exercise testing and prescription. Third edition. Baltimore: Williams and Wilkins; 1998. p. 146–55.
22.
go back to reference Rowland TW. Aerobic exercise testing protocols. In: Rowland TW, editor. Pediatric Laboratory Exercise Testing: Clinical Guidelines. Champaign, Ill: Human Kinetics; 1993. p. 19–41. Rowland TW. Aerobic exercise testing protocols. In: Rowland TW, editor. Pediatric Laboratory Exercise Testing: Clinical Guidelines. Champaign, Ill: Human Kinetics; 1993. p. 19–41.
23.
go back to reference Cooper DM, Weiler-Ravell D, Whipp BJ, Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol. 1984;56:628–34. Cooper DM, Weiler-Ravell D, Whipp BJ, Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol. 1984;56:628–34.
24.
go back to reference Astrand PO. Experimental studies of physical work capacity in relation to sex and age: Copenhagen, Munkgaard; 1952. Astrand PO. Experimental studies of physical work capacity in relation to sex and age: Copenhagen, Munkgaard; 1952.
25.
go back to reference Owens S, Gutin B. Exercise testing of the child with obesity. Pediatr Cardiol. 1999;20:79–83. Owens S, Gutin B. Exercise testing of the child with obesity. Pediatr Cardiol. 1999;20:79–83.
26.
go back to reference Tanner JM. Fallacy of per weight and per surface area standards and their relation to spurius correlation. J Appl Physiol. 1949;2: 1–15. Tanner JM. Fallacy of per weight and per surface area standards and their relation to spurius correlation. J Appl Physiol. 1949;2: 1–15.
27.
go back to reference Schmidt-Nielsen K. Scaling: Why is animal size so important? Cambridge: Cambridge University Press; 1984. Schmidt-Nielsen K. Scaling: Why is animal size so important? Cambridge: Cambridge University Press; 1984.
28.
go back to reference Weibel ER, Hoppeler H. Exercise-induced maximal metabolic rate scales with muscle aerobic capacity. J Exp Biol. 2005;208: 1635–44. Weibel ER, Hoppeler H. Exercise-induced maximal metabolic rate scales with muscle aerobic capacity. J Exp Biol. 2005;208: 1635–44.
29.
go back to reference Hermansen L, Ekblom B, Saltin B. Cardiac output during submaximal and maximal treadmill and bicycle exercise. J Appl Physiol. 1970;29:82–6. Hermansen L, Ekblom B, Saltin B. Cardiac output during submaximal and maximal treadmill and bicycle exercise. J Appl Physiol. 1970;29:82–6.
30.
go back to reference Hermansen L, Saltin B. Oxygen uptake during maximal treadmill and bicycle exercise. J Appl Physiol. 1969;26:31–7. Hermansen L, Saltin B. Oxygen uptake during maximal treadmill and bicycle exercise. J Appl Physiol. 1969;26:31–7.
31.
go back to reference Astrand P, Rodahl K, Astrand PRK. Textbook of work physiology, physiological bases of exercise. New York: McGraw-Hill Book Company; 1986. Astrand P, Rodahl K, Astrand PRK. Textbook of work physiology, physiological bases of exercise. New York: McGraw-Hill Book Company; 1986.
32.
go back to reference Ohuchi H. Cardiopulmonary response to exercise in patients with the Fontan Circulation. Cardiol Young. 2005;15 Suppl 3:39–44. Ohuchi H. Cardiopulmonary response to exercise in patients with the Fontan Circulation. Cardiol Young. 2005;15 Suppl 3:39–44.
33.
go back to reference McManus A, Leung M. Maximising the clinical use of exercise gaseous exchange testing in children with repaired cyanotic congenital heart defects: the development of an appropriate test strategy. Sports Med. 2000;29:229–44. McManus A, Leung M. Maximising the clinical use of exercise gaseous exchange testing in children with repaired cyanotic congenital heart defects: the development of an appropriate test strategy. Sports Med. 2000;29:229–44.
34.
go back to reference Singh TP, Rhodes J, Gauvreau K. Determinants of heart rate recovery following exercise in children. Med Sci Sports Exerc. 2008;40:601–5. Singh TP, Rhodes J, Gauvreau K. Determinants of heart rate recovery following exercise in children. Med Sci Sports Exerc. 2008;40:601–5.
35.
go back to reference Singh TP, Curran TJ, Rhodes J. Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol. 2007;28:276–9. Singh TP, Curran TJ, Rhodes J. Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol. 2007;28:276–9.
36.
go back to reference Godfrey S. Exercise testing in children. London: W.B. Saunders Company Ltd.; 1974. Godfrey S. Exercise testing in children. London: W.B. Saunders Company Ltd.; 1974.
37.
go back to reference Driscoll DJ, Staats BA, Beck KC. Measurement of Cardiac Output in Children During Exercise: A Review. Pediatr Exerc Sci. 1989;1: 102–15. Driscoll DJ, Staats BA, Beck KC. Measurement of Cardiac Output in Children During Exercise: A Review. Pediatr Exerc Sci. 1989;1: 102–15.
38.
go back to reference Baba R, Nagashima M, Nagano Y, Ikoma M, Nishibata K. Role of the oxygen uptake efficiency slope in evaluating exercise tolerance. Arch Dis Child. 1999;81:73–5. Baba R, Nagashima M, Nagano Y, Ikoma M, Nishibata K. Role of the oxygen uptake efficiency slope in evaluating exercise tolerance. Arch Dis Child. 1999;81:73–5.
39.
go back to reference Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996;28:1567–72. Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996;28:1567–72.
40.
go back to reference Marinov B, Mandadzhieva S, Kostianev S. Oxygen-uptake efficiency slope in healthy 7- to 18-year-old children. Pediatr Exerc Sci. 2007;19:159–70. Marinov B, Mandadzhieva S, Kostianev S. Oxygen-uptake efficiency slope in healthy 7- to 18-year-old children. Pediatr Exerc Sci. 2007;19:159–70.
41.
go back to reference Groen WG, Hulzebos EH, Helders PJ, Takken, T. Oxygen Uptake To Work Rate Relationship During Exercise In Children With Lung, Heart or Muscle Disease. Med Sci Sports Exerc. 2009;41:S5, Abstract 1658. Groen WG, Hulzebos EH, Helders PJ, Takken, T. Oxygen Uptake To Work Rate Relationship During Exercise In Children With Lung, Heart or Muscle Disease. Med Sci Sports Exerc. 2009;41:S5, Abstract 1658.
42.
go back to reference Hansen JE, Sue DY, Oren A, Wasserman K. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders. Am J Cardiol. 1987;59:669–74. Hansen JE, Sue DY, Oren A, Wasserman K. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders. Am J Cardiol. 1987;59:669–74.
43.
go back to reference Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of Exercise Testing and Interpretation. Baltimore, MD: Lippincott, Williams and Wilkins; 1999. Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of Exercise Testing and Interpretation. Baltimore, MD: Lippincott, Williams and Wilkins; 1999.
44.
go back to reference Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM. Excessive anaerobic metabolism during exercise after repair of aortic coarctation. J Pediatr. 1997;131:210–4. Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM. Excessive anaerobic metabolism during exercise after repair of aortic coarctation. J Pediatr. 1997;131:210–4.
45.
go back to reference Eschenbacher WL, Mannina A. An algorithm for the interpretation of cardiopulmonary exercise tests. Chest. 1990;97:263–7. Eschenbacher WL, Mannina A. An algorithm for the interpretation of cardiopulmonary exercise tests. Chest. 1990;97:263–7.
46.
go back to reference Riopel DA, Taylor AB, Hohn AR. Blood pressure, heart rate, pressure-rate product and electrocardiographic changes in healthy children during treadmill exercise. Am J Cardiol. 1979;44:697–704. Riopel DA, Taylor AB, Hohn AR. Blood pressure, heart rate, pressure-rate product and electrocardiographic changes in healthy children during treadmill exercise. Am J Cardiol. 1979;44:697–704.
47.
go back to reference Rowell LB, O'Leary DS. Reflex control of the circulation during exercise: chemoreflexes and mechanoreflexes. J Appl Physiol. 1990; 69:407–18. Rowell LB, O'Leary DS. Reflex control of the circulation during exercise: chemoreflexes and mechanoreflexes. J Appl Physiol. 1990; 69:407–18.
48.
go back to reference Turley KR, Wilmore JH. Cardiovascular responses to treadmill and cycle ergometer exercise in children and adults. J Appl Physiol. 1997;83:948–57. Turley KR, Wilmore JH. Cardiovascular responses to treadmill and cycle ergometer exercise in children and adults. J Appl Physiol. 1997;83:948–57.
49.
go back to reference Reybrouck T, Rogers R, Weymans M, Dumoulin M, Vanhove M, Daenen W, et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr. 1995;154:801–6. Reybrouck T, Rogers R, Weymans M, Dumoulin M, Vanhove M, Daenen W, et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr. 1995;154:801–6.
50.
go back to reference De Groot JF, Takken T, Schoenmakers MA, Vanhees L, Helders PJ. Limiting factors in peak oxygen uptake and the relationship with functional ambulation in ambulating children with Spina Bifida. Eur J Appl Physiol. 2008;104:657–65. De Groot JF, Takken T, Schoenmakers MA, Vanhees L, Helders PJ. Limiting factors in peak oxygen uptake and the relationship with functional ambulation in ambulating children with Spina Bifida. Eur J Appl Physiol. 2008;104:657–65.
Metagegevens
Titel
Cardiopulmonary exercise testing in congenital heart disease: (contra)indications and interpretation
Auteurs
T. Takken
A. C. Blank
E. H. Hulzebos
M. van Brussel
W. G. Groen
P. J. Helders
Publicatiedatum
01-10-2009
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 10/2009
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/BF03086289

Andere artikelen Uitgave 10/2009

Netherlands Heart Journal 10/2009 Naar de uitgave