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Pieles GE, Dorobantu DM, Caterini JE, Cifra B, Reyes J, Roldan Ramos S, Hannon E, Williams CA, Humpl T, Mertens L, Wells GD, Friedberg MK. Biventricular responses to exercise and their relation to cardiorespiratory fitness in pediatric pulmonary hypertension. Am J Physiol Heart Circ Physiol 2024; 327:H749-H764. [PMID: 39058433 PMCID: PMC11482283 DOI: 10.1152/ajpheart.00096.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/10/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Despite exercise intolerance being predictive of outcomes in pulmonary arterial hypertension (PAH), its underlying cardiac mechanisms are not well described. The aim of the study was to explore the biventricular response to exercise and its associations with cardiorespiratory fitness in children with PAH. Participants underwent incremental cardiopulmonary exercise testing and simultaneous exercise echocardiography on a recumbent cycle ergometer. Linear mixed models were used to assess cardiac function variance and associations between cardiac and metabolic parameters during exercise. Eleven participants were included with a mean age of 13.4 ± 2.9 yr old. Right ventricle (RV) systolic pressure (RVsp) increased from a mean of 59 ± 25 mmHg at rest to 130 ± 40 mmHg at peak exercise (P < 0.001), whereas RV fractional area change (RV-FAC) and RV-free wall longitudinal strain (RVFW-Sl) worsened (35.2 vs. 27%, P = 0.09 and -16.6 vs. -14.6%, P = 0.1, respectively). At low- and moderate-intensity exercise, RVsp was positively associated with stroke volume and O2 pulse (P < 0.1). At high-intensity exercise, RV-FAC, RVFW-Sl, and left ventricular longitudinal strain were positively associated with oxygen uptake and O2 pulse (P < 0.1), whereas stroke volume decreased toward peak (P = 0.04). In children with PAH, the increase of pulmonary pressure alone does not limit peak exercise, but rather the concomitant reduced RV functional reserve, resulting in RV to pulmonary artery (RV-PA) uncoupling, worsening of interventricular interaction and LV dysfunction. A better mechanistic understanding of PAH exercise physiopathology can inform stress testing and cardiac rehabilitation in this population.NEW & NOTEWORTHY In children with pulmonary arterial hypertension, there is a marked increase in pulmonary artery pressure during physical activity, but this is not the underlying mechanism that limits exercise. Instead, right ventricle-to-pulmonary artery uncoupling occurs at the transition from moderate to high-intensity exercise and correlates with lower peak oxygen uptake. This highlights the more complex underlying pathological responses and the need for multiparametric assessment of cardiac function reserve in these patients when feasible.
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Affiliation(s)
- Guido E Pieles
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Sport, Exercise and Health, University College London, London, United Kingdom
- Sports Cardiology Department, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Dan-Mihai Dorobantu
- Children's Health and Exercise Research Center, University of Exeter, Exeter, United Kingdom
- Congenital Heart Disease Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, United Kingdom
| | - Jessica E Caterini
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Barbara Cifra
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Janette Reyes
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sara Roldan Ramos
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eilis Hannon
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, United Kingdom
| | - Craig A Williams
- Children's Health and Exercise Research Center, University of Exeter, Exeter, United Kingdom
| | - Tilman Humpl
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Greg D Wells
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Unnithan VB, Beaumont A, Rowland T, George K, Stewart L, Sculthorpe N, Lord RN, Oxborough DL. The effect of long-term soccer training on left ventricular structure and function in elite male youth soccer players. Scand J Med Sci Sports 2024; 34:e14594. [PMID: 38454596 DOI: 10.1111/sms.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
AIMS Cardiac adaptations in elite, male adolescent youth soccer players have been demonstrated in relation to training status. The time course of these adaptations and the delineation of the influence of volatile growth phases from the training effect on these adaptations remain unclear. Consequently, the aims of the study were to evaluate the impact of 3 years of elite-level soccer training on changes in left ventricular (LV) structure and function in a group of highly trained elite youth male soccer players (SP) as they transitioned through the pre-to-adolescent phase of their growth. METHODS Twenty-two male youth SP from the highest Level of English Premier League Academy U-12 teams were evaluated once a year for three soccer seasons as the players progressed from the U-12 to U-14 teams. Fifteen recreationally active control participants (CON) were also evaluated over the same 3-year period. Two-dimensional transthoracic echocardiography was used to quantify LV structure and function. RESULTS After adjusting for the influence of growth and maturation, training-induced increases in Years 2 and 3 were noted for: LV end diastolic volume (LVEDV; p = 0.02) and LV end systolic volume (LVESV; p = 0.02) in the SP compared to CON. Training-induced decrements were noted for LV ejection fraction (LVEF; p = 0.006) and TDI-S' (p < 0.001). CONCLUSIONS An increase in training volume (Years 2 and 3) were aligned with LV volumetric adaptations and decrements in systolic function in the SP that were independent from the influence of rapid somatic growth. Decrements in systolic function were suggestive of a functional reserve for exercise.
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Affiliation(s)
- Viswanath B Unnithan
- Division of Sport and Exercise, School of Health and Life Sciences, Sport and Physical Activity Research Institute, University of the West of Scotland, Hamilton, UK
| | - Alexander Beaumont
- School of Science, Technology and Health, York St. John University, York, UK
| | - Thomas Rowland
- Division of Sport and Exercise, School of Health and Life Sciences, Sport and Physical Activity Research Institute, University of the West of Scotland, Hamilton, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Laura Stewart
- School of Computing, Engineering, and Physical Sciences, University of the West of Scotland, Paisley, UK
| | - Nicholas Sculthorpe
- Division of Sport and Exercise, School of Health and Life Sciences, Sport and Physical Activity Research Institute, University of the West of Scotland, Hamilton, UK
| | - Rachel N Lord
- Cardiff Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Dorobantu DM, Wadey CA, Berryman B, Amir NH, Forsythe L, Stuart AG, Pieles GE, Williams CA. A new protocol for a single-stage combined cardiopulmonary and echocardiography exercise test: a pilot study. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae021. [PMID: 39045209 PMCID: PMC11195695 DOI: 10.1093/ehjimp/qyae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/11/2024] [Indexed: 07/25/2024]
Abstract
Aims The value of cardiopulmonary exercise testing (CPET) and exercise stress echocardiography (ESE) in managing cardiac disease is well known, but no standard CPET-ESE protocol is currently recommended. This pilot study aims to compare feasibility and cardiac function responses between a new high-intensity single-stage combined test (CPET-hiESE) and a standard maximal ESE (smESE). Methods and results After screening and maximal CPET, all volunteers (n = 21) underwent three ESE modalities: (i) based on the gas exchange threshold (hiESE-GET, 40% of peak-GET, 6 min), (ii) based on heart rate (HR) (hiESE-HR, 80% of peak HR, 6 min), and (iii) smESE (85% of predicted peak HR for age, 3 min). Speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) were measured at each step. There was superior image quality and data completeness for the right ventricle strain for both hiESE modalities compared with smESE (71.4 and 76.2 vs. 42.9%, P = 0.07). Left ventricular STE data completeness was similar for all three conditions. Despite systematically higher HR, work rate and levels of exertion in the smESE compared with hiESE, STE and TDI parameters were not systematically different. Concordance correlation coefficients ranged from 0.56 to 0.88, lowest for strain rate parameters and mean difference from -0.34 to 1.53, highest for TDI measurements. Conclusion The novel CPET-hiESE protocol allowed for better data completeness, at lower levels of exertion compared with smESE, without systematically different cardiac reserve measurements in healthy participants. This single-stage protocol can be individualized to clinical populations, which would provide practical advantages to standard testing.
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Affiliation(s)
- Dan M Dorobantu
- Children’s Health and Exercise Research Centre (CHERC), Public Health and Sports Sciences, Faculty of Life and Health Sciences, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU, UK
- Population and Translational Health Sciences, University of Bristol, Bristol, Beacon House, Queens Rd, BS8 1QU, UK
| | - Curtis A Wadey
- Children’s Health and Exercise Research Centre (CHERC), Public Health and Sports Sciences, Faculty of Life and Health Sciences, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - Ben Berryman
- Children’s Health and Exercise Research Centre (CHERC), Public Health and Sports Sciences, Faculty of Life and Health Sciences, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - Nurul H Amir
- Population and Translational Health Sciences, University of Bristol, Bristol, Beacon House, Queens Rd, BS8 1QU, UK
- Faculty of Sport Science and Recreation, Universiti Teknologi MARA, Perlis Branch, Arau Campus, Uitm Arau, 02600 Arau, Malaysia
| | - Lynsey Forsythe
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Upper Maudlin St, BS2 8BJ, Bristol, UK
| | - A Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Upper Maudlin St, BS2 8BJ, Bristol, UK
| | - Guido E Pieles
- Sports Cardiology and Screening Department, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, Qatar
- Institute of Sport Exercise and Health, University College London, 170 Tottenham Ct Rd, W1T 7HA, London, UK
| | - Craig A Williams
- Children’s Health and Exercise Research Centre (CHERC), Public Health and Sports Sciences, Faculty of Life and Health Sciences, University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU, UK
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Palermi S, Cavarretta E, D’Ascenzi F, Castelletti S, Ricci F, Vecchiato M, Serio A, Cavigli L, Bossone E, Limongelli G, Biffi A, Monda E, La Gerche A, Baggish A, D’Andrea A. Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach. Rev Cardiovasc Med 2023; 24:151. [PMID: 39076743 PMCID: PMC11273059 DOI: 10.31083/j.rcm2405151] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/16/2023] [Accepted: 05/04/2023] [Indexed: 07/31/2024] Open
Abstract
"Athlete's heart" is a spectrum of morphological, functional, and regulatory changes that occur in people who practice regular and long-term intense physical activity. The morphological characteristics of the athlete's heart may overlap with some structural and electrical cardiac diseases that may predispose to sudden cardiac death, including inherited and acquired cardiomyopathies, aortopathies and channelopathies. Overdiagnosis should be avoided, while an early identification of underlying cardiac life-threatening disorders is essential to reduce the potential for sudden cardiac death. A step-by-step multimodality approach, including a first-line evaluation with personal and family history, clinical evaluation, 12-lead resting electrocardiography (ECG), followed by second and third-line investigations, as appropriate, including exercise testing, resting and exercise echocardiography, 24-hour ECG Holter monitoring, cardiac magnetic resonance, computed tomography, nuclear scintigraphy, or genetic testing, can be determinant to differentiate between extreme physiology adaptations and cardiac pathology. In this context, cardiovascular imaging plays a key role in detecting structural abnormalities in athletes who fall into the grey zone between physiological adaptations and a covert or early phenotype of cardiovascular disease.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G.d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Eduardo Bossone
- Division of Cardiology, AORN A Cardarelli Hospital, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Antonello D’Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Salerno, Italy
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Unnithan VB, Beaumont A, Rowland T, George K, Sculthorpe N, Lord RN, Bakhshi A, Oxborough D. Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation. J Cardiovasc Dev Dis 2022; 9:jcdd9120438. [PMID: 36547435 PMCID: PMC9787332 DOI: 10.3390/jcdd9120438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
There is an increase in the prevalence of elite youth sports academies, whose sole aim is to develop future elite athletes. This involves the exposure of the child and adolescent athlete to high-volume training during a period of volatile growth. The large amount of data in this area has been garnered from the resting echocardiographic left ventricular (LV) evaluation of the youth athlete; while this can provide some insight on the functional adaptations to training, it is unable to elucidate a comprehensive overview of the function of the youth athletes' LV during exercise. Consequently, there is a need to interrogate the LV responses in-exercise. This review outlines the feasibility and functional insight of capturing global indices of LV function (Stroke Index-SVIndex and Cardiac Index-QIndex), systolic and diastolic markers, and cardiac strain during submaximal and maximal exercise. Larger SVI and QI were noted in these highly trained young athletes compared to recreationally active peers during submaximal and maximal exercise. The mechanistic insights suggest that there are minimal functional systolic adaptions during exercise compared to their recreationally active peers. Diastolic function was superior during exercise in these young athletes, and this appears to be underpinned by enhanced determinants of pre-load.
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Affiliation(s)
- Viswanath B. Unnithan
- Sport and Physical Activity Research Institute, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton G72 0LH, UK
- Correspondence: ; Tel.: +44-01698-894413
| | - Alexander Beaumont
- School of Science, Technology and Health, York St. John University, York YO31 7EX, UK
| | - Thomas Rowland
- Sport and Physical Activity Research Institute, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton G72 0LH, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Nicholas Sculthorpe
- Sport and Physical Activity Research Institute, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton G72 0LH, UK
| | - Rachel N. Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff CF5 2YB, UK
| | | | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
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Unnithan VB, Rowland T, George K, Bakhshi A, Beaumont A, Sculthorpe N, Lord RN, Oxborough DL. The effect of long-term soccer training on changes in cardiac function during exercise in elite youth soccer players. Scand J Med Sci Sports 2022; 32:892-902. [PMID: 35114040 DOI: 10.1111/sms.14140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
Abstract
It is unclear what the effect of long-term, high-volume soccer training has on left ventricular (LV) function during exercise in youth soccer players. This study evaluated changes in LV function during submaximal exercise in a group of highly-trained male soccer players (SP) as they transitioned over a three-year period from pre-adolescent to adolescent athletes. Data were compared to age-and sex-matched recreationally active controls (CON) over the same time period. Twenty-two SP from two professional English Premier League youth soccer academies (age: 12.0 ± 0.3 years at start of the study) and 15 CON (age: 11.7 ± 0.3 years) were recruited. Two-dimensional echocardiography was used to quantify LV function during exercise at the same submaximal metabolic load (approx. 45%VO2 peak) across the 3 years. After controlling for growth and maturation, there were training-induced changes and superiority (p<0.001) in cardiac index (QIndex) from year 1 in the SP compared to CON. SP (year 1: 6.13 ± 0.76; year 2: 6.94 ± 1.31 and year 3: 7.20 ± 1.81 L/min/m2 ) compared to CON (year 1: 5.15 ± 1.12; year 2: 4.67 ± 1.04 and year 3: 5.49 ± 1.06 L/min/m2 ). Similar training-induced increases were noted for mitral inflow velocity (E): SP (year 1: 129 ± 12; year 2: 143 ± 16 and year 3: 135 ± 18 cm/s) compared to CON (year 1: 113 ± 10; year 2: 111 ± 12 and year 3: 121 ± 9 cm/s).This study indicated that there was evidence of yearly, training-induced increases in left ventricular function during submaximal exercise independent from the influence of growth and maturation in elite youth SP.
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Affiliation(s)
- Viswanath Balagopalan Unnithan
- Institute of Clinical Exercise and Health Science, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton, Scotland, UK
| | - Thomas Rowland
- Institute of Clinical Exercise and Health Science, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton, Scotland, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | | | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton, Scotland, UK
| | - Rachel Nia Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - David Lee Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Meinel K, Koestenberger M, Sallmon H, Hansmann G, Pieles GE. Echocardiography for the Assessment of Pulmonary Hypertension and Congenital Heart Disease in the Young. Diagnostics (Basel) 2020; 11:diagnostics11010049. [PMID: 33396225 PMCID: PMC7823322 DOI: 10.3390/diagnostics11010049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022] Open
Abstract
While invasive assessment of hemodynamics and testing of acute vasoreactivity in the catheterization laboratory is the gold standard for diagnosing pulmonary hypertension (PH) and pulmonary vascular disease (PVD) in children, transthoracic echocardiography (TTE) serves as the initial diagnostic tool. International guidelines suggest several key echocardiographic variables and indices for the screening studies when PH is suspected. However, due to the complex anatomy and special physiological considerations, these may not apply to patients with congenital heart disease (CHD). Misinterpretation of TTE variables can lead to delayed diagnosis and therapy, with fatal consequences, or–on the other hand-unnecessary invasive diagnostic procedures that have relevant risks, especially in the pediatric age group. We herein provide an overview of the echocardiographic workup of children and adolescents with PH with a special focus on children with CHD, such as ventricular/atrial septal defects, tetralogy of Fallot or univentricular physiology. In addition, we address the use of echocardiography as a tool to assess eligibility for exercise and sports, a major determinant of quality of life and outcome in patients with PH associated with CHD.
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Affiliation(s)
- Katharina Meinel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, 8036 Graz, Austria; (K.M.); (M.K.)
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
| | - Hannes Sallmon
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), 13353 Berlin, Germany
| | - Georg Hansmann
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, 30625 Hannover, Germany
| | - Guido E. Pieles
- European Pediatric Pulmonary Vascular Disease Network, 13125 Berlin, Germany; (H.S.); (G.H.)
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol BS2 8HW, UK
- Institute of Sport Exercise and Health (ISEH), University College London, London W1T 7HA, UK
- Correspondence:
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