Open Access

ARTICLE

The utility of combined cardiopulmonary exercise stress testing in the evaluation of pediatric patients with chest pain

Soham Dasgupta¹, Megan Stark², Sonal Bhatt³, Peter Fischbach¹, Shriprasad Deshpande¹

1 Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
2 Department of Exercise Physiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
3 Children’s Healthcare of Atlanta, Atlanta, Georgia

* Corresponding Author: Dr. Soham Dasgupta, Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322. Email:

Congenital Heart Disease 2018, 13(6), 1058-1063. https://doi.org/10.1111/chd.12681

Abstract

Introduction: A cardiac cause is an extremely rare etiology of pediatric chest pain. Despite its low sensitivity/specificity, exercise stress testing (EST) is widely used to determine the prognosis in patients with suspected/established coronary disease. We aimed to look at the utility of a combined cardiopulmonary EST in the evaluation of pediatric patients with chest pain.
Methods: After institutional review board approval, a retrospective chart review was performed of all pediatric patients who were referred for an EST for chest pain from January 2014 to 2017. Patients with incomplete records, severe congenital heart disease, and a prior EST were excluded.
Results: A total of 389 patients met the inclusion criteria. Echocardiogram (ECHO) was performed on 333 (85.6%) patients and 43 (11%) previously unknown structural cardiac anomalies were identified. A total of 76 (19.5%) patients had an abnormal EST with the 3 most common causes being related to the respiratory system. Only four patients had both an abnormal exercise stress test and an incidental structural anomaly on ECHO but none of them had their symptoms recreated during the EST.
Conclusion: Only 1% of patients previously undiagnosed with heart disease had an abnormal stress test and an incidental anomaly on ECHO. These ECHO anomalies were unlikely to be the cause of chest pain. Furthermore, since the majority of abnormal stress tests were secondary to a pulmonary cause, a complete cardiopulmonary EST may be an effective screening tool for certain patients presenting with chest pain. Our study emphasizes the need for performing a complete cardiopulmonary EST instead of an isolated cardiac stress test to maximize diagnostic efficiency and yield.

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