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Ziebell D, Patel T, Stark M, Xiang Y, Oster ME. Exercise testing in patients with multisystem inflammatory syndrome in children-related myocarditis versus idiopathic or viral myocarditis. Cardiol Young 2023; 33:2215-2220. [PMID: 36624558 DOI: 10.1017/s1047951122004140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND While most children with multisystem inflammatory syndrome in children have rapid recovery of cardiac dysfunction, little is known about the long-term outcomes regarding exercise capacity. We aimed to compare the exercise capacity among patients with multisystem inflammatory syndrome in children versus viral/idiopathic myocarditis at 3-6 months after initial diagnosis. METHODS We performed a retrospective cohort study among patients with multisystem inflammatory syndrome in children in June 2020 to May 2021 and patients with viral/idiopathic myocarditis in August 2014 to January 2020. Data from cardiopulmonary exercise test as well as echocardiographic and laboratory data were obtained. Inclusion criteria included diagnosis of multisystem inflammatory syndrome in children or viral/idiopathic myocarditis, exercise test performed within 3-6 months of hospital discharge, and maximal effort on cardiopulmonary exercise test as determined by respiratory exchange ratio >1.10. RESULTS Thirty-one patients with multisystem inflammatory syndrome in children and 25 with viral/idiopathic myocarditis were included. The mean percent predicted peak VO2 was 90.84% for multisystem inflammatory syndrome in children patients and 91.08% for those with viral/idiopathic myocarditis (p-value 0.955). There were no statistically significant differences between the groups with regard to percent predicted maximal heart rate, metabolic equivalents, percent predicted peak VO2, percent predicted anerobic threshold, or percent predicted O2 pulse. There was a statistically significant correlation between lowest ejection fraction during hospitalisation and peak VO2 among viral/idiopathic myocarditis patients (r: 0.62, p-value 0.01) but not multisystem inflammatory syndrome in children patients (r: 0.1, p-value 0.6). CONCLUSIONS Patients with multisystem inflammatory syndrome in children and viral myocarditis appear to, on average, have normal exercise capacity around 3-6 months following hospital discharge. For patients with viral/idiopathic myocarditis, those with worse ejection fraction during hospitalisation had lower peak VO2 on cardiopulmonary exercise test.
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Affiliation(s)
| | | | - Megan Stark
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Yijin Xiang
- Pediatric Biostatistics Core, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Matthew E Oster
- Emory University, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Mascherini G, Galanti G, Stefani L, Izzicupo P. Normative values and a new predicted model of exercise blood pressure in young athletes. J Sci Med Sport 2023; 26:3-7. [PMID: 36379874 DOI: 10.1016/j.jsams.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Assessing the systolic and diastolic blood pressure during acute physical exertion can allow the discovery of many cardiovascular diseases even at a young age. However, this response depends on the age, sex of the subject, and the modality of the graded exercise test. This study aims to provide sex-and age-related normative values of peak and recovery blood pressure performance and to develop a predicted model of systolic and diastolic blood pressure peak in young athletes. DESIGN Retrospective-study. METHODS We analyzed 8224 young athletes (5516 males and 2708 females) aged between 8 and 18. Anthropometric and blood pressure parameters related to the effort are reported. Then, according to sex, graded exercise test modality, and age were calculated 1) the fifth, tenth, fiftieth, ninetieth, and ninety-fifth percentiles for the systolic and diastolic blood pressure at peak and after 1 min of recovery and 2) predictive equations of systolic and diastolic blood pressure at the peak. RESULTS Younger athletes show lower peak blood pressure values, gradually increasing as they age. Males showed higher peak systolic blood pressure values starting at 12-13 years on the cycle ergometer and 10-11 years on the treadmill, while there was no difference in peak diastolic blood pressure values. CONCLUSIONS Sex, age, and the specificity of the movement performed must be considered in assessing the blood pressure response in the young population. In addition, providing reference values and predictive equations of blood pressure response to acute physical exertion may allow for a better functional assessment of young athletes.
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Affiliation(s)
- Gabriele Mascherini
- Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Giorgio Galanti
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Laura Stefani
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Italy
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Alvarez-Pitti J, Herceg-Čavrak V, Wójcik M, Radovanović D, Brzeziński M, Grabitz C, Wühl E, Drożdż D, Melk A. Blood pressure response to exercise in children and adolescents. Front Cardiovasc Med 2022; 9:1004508. [PMID: 36247478 PMCID: PMC9561233 DOI: 10.3389/fcvm.2022.1004508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/08/2022] [Indexed: 11/27/2022] Open
Abstract
Blood pressure changes during exercise are part of the physiological response to physical activity. Exercise stress testing can detect an exaggerated blood pressure response in children and adolescent. It is applied for certain clinical conditions, but is also commonly used as part of the assessment of athletes. The interpretation of blood pressure values in response to exercise during childhood and adolescence requires appropriate reference data. We discuss the available reference values and their limitations with regard to device, exercise protocol and normalization. While the link between an exaggerated blood pressure response and cardiovascular events and mortality has been demonstrated for adults, the situation is less clear for children and adolescents. We discuss the existing evidence and propose that under certain circumstances it might be reasonable to have children and adolescents undergo exercise stress testing as a rather non-invasive procedure to add additional information with regard to their cardiovascular risk profile. Based on the existing data future studies are needed to extend our current knowledge on possible links between the presence of certain clinical conditions, the detectability of an exaggerated blood pressure response during childhood and adolescence and the risk of developing cardiovascular morbidity and mortality in later life.
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Affiliation(s)
- Julio Alvarez-Pitti
- Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- INCLIVA Biomedical Research Institute, Hospital Clínico, University of Valencia, Valencia, Spain
| | - Vesna Herceg-Čavrak
- Faculty of Health Science, Libertas International University, Zagreb, Croatia
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Dragan Radovanović
- Department of Medical Sciences, Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Michał Brzeziński
- Department of Pediatrics, Gastroenterology, Allergology and Pediatric Nutrition, Medical University of Gdansk, Gdańsk, Poland
| | - Carl Grabitz
- Children’s Hospital, Hannover Medical School, Hanover, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Pediatric Institute, Jagiellonian University Medical College, Kraków, Poland
- Dorota Drożdż,
| | - Anette Melk
- Children’s Hospital, Hannover Medical School, Hanover, Germany
- *Correspondence: Anette Melk,
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5
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Wuestenfeld JC, Baersch F, Ruedrich P, Paech C, Wolfarth B. Blood pressure response to dynamic exercise testing in adolescent elite athletes, what is normal? Front Pediatr 2022; 10:974926. [PMID: 36340728 PMCID: PMC9635448 DOI: 10.3389/fped.2022.974926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In general, only few studies are dedicated to blood pressure behavior under physical stress in children and adolescents. Even less is published about the blood pressure behavior of young high-performance athletes on the ergometer. For this reason, we evaluated the blood pressure behavior under stress compared to non-athletes in a large collective (n = 739) of young high-performance athletes (age 10-20 years, mean 15.8 years, male 442, female 297) of different sports. A complete echocardiographic examination was available in all athletes. RESULT Regardless of gender, the young competitive athletes achieved significantly higher maximum blood pressure values than investastigated populations from previous studies. Based on the data obtained, blood pressure percentiles are now defined explicitly for junior athletes across sports as well as age- and gender-dependent, which did not exist in this form of normal values for the special clientele of young competitive athletes. The echocardiographic examinations demonstrated stress-induced cardiac adaptation adaptations in the majority of athletes, which thus correlate with the comparatively higher stress blood pressures compared to non-athletes. CONCLUSION For the first time, blood pressure percentiles for exercise tests on the ergometer for age groups and gender in high performance athletes are defined based on a comparatively large collective of young competitive athletes. Upper limits were determined, in particular for systolic blood pressure under stress, and categorized according to gender and age. Performance diagnosticians and physicians are now enabled to make a more accurate assessment of the corresponding blood pressure regulation of young athletes under exercise conditions.
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Affiliation(s)
- J C Wuestenfeld
- Department Sports Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Berlin, Germany.,Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| | - F Baersch
- Faculty of Sports Science, Institut of Sports Medicine, University Leipzig, Leipzig, Germany
| | - P Ruedrich
- Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| | - C Paech
- Department for Pediatric Cardiology, University of Leipzig -Heart Center Leipzig, Leipzig, Germany
| | - B Wolfarth
- Department Sports Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Berlin, Germany.,Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
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Clarke MM, Zannino D, Stewart NP, Glenning JP, Pineda-Guevara S, Kik J, Mynard JP, Cheung MMH. Normative blood pressure response to exercise stress testing in children and adolescents. Open Heart 2021; 8:openhrt-2021-001807. [PMID: 34663749 PMCID: PMC8524376 DOI: 10.1136/openhrt-2021-001807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To describe normative values for blood pressure (BP) response to maximal exercise in children/adolescents undergoing a treadmill stress test. Methods From a retrospective analysis of medical records, patients who had undergone a Bruce protocol exercise stress test, with (1) normal cardiovascular system and (2) a body mass index percentile rank below 95% were included for analysis. Sex, age, height, weight, resting and peak heart rate, resting and peak systolic blood pressure (SBP), test duration, stage of Bruce protocol at termination, reason for undergoing the test and reason for termination of test were collected. Percentiles for exercise-induced changes in SBP were constructed by age and height for each sex with the use of quantile regression models. Results 648 patients with a median age of 12.4 years (range 6–18 years) were included. Typical indications for stress testing were investigation of potential rhythm abnormalities, syncope/dizziness and chest pain and were deemed healthy by an overseeing cardiologist. Mean test duration was 12.6±2.2 min. Reference percentiles for change in SBP by sex, age and height are presented. Conclusion The presented reference percentiles for the change in SBP for normal children and adolescents will have utility for detecting abnormally high or low BP responses to exercise in these age groups.
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Affiliation(s)
- Melanie M Clarke
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Natalie P Stewart
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jonathan P Glenning
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | | | - Jolien Kik
- Department of Cardiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Medical Education, University of Groningen, Groningen, The Netherlands
| | - Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Biomedical Engineering, Faculty of Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Cardiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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