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Pediatr Cardiol. 2019 Oct;40(7):1516-1522. doi: 10.1007/s00246-019-02177-1. Epub 2019 Aug 7.

Correlation of Echocardiogram and Exercise Test Data in Children with Aortic Stenosis.

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Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
Division of Pediatric Cardiology, Medical University of South Carolina, 165 Ashley Ave., MSC915, Charleston, SC, 29425, USA.
Familial Hypercholesterolemia Foundation, 959 East Walnut St., Suite 220, Pasadena, CA, 91106, USA.
Nemours/Alfred I. duPont Hospital for Children, Nemours Biomedical Research, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA.
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St., #100, Philadelphia, PA, 19107, USA.


Previous pediatric exercise test criteria for aortic stenosis severity were based on cardiac catheterization assessment, whereas current criteria are based on echocardiographic valve gradients. We sought to correlate exercise test criteria with echocardiographic assessment of severity. We report 65 studies, 51 patients (mean age of 13 ± 4 years; 75% males), with aortic stenosis (AS) who had a maximal exercise test between 2005 and 2016. We defined three groups based on resting mean Doppler gradient across their aortic valve: severe AS (n = 10; gradient of ≥ 40 mmHg), moderate AS (n = 20; gradient 25-39 mmHg), and mild AS (n = 35; gradient ≤ 24 mmHg). We studied symptoms (chest pain) during exercise, resting electrocardiogram changes (left ventricular hypertrophy [LVH]), complex arrhythmias during exercise, change in exercise systolic blood pressure (SBP; delta SBP = peak SBP-resting SBP), exercise duration, work, echocardiogram parameters (LVH), and ST-T wave changes with exercise. Additionally, we compared work and delta SBP during exercise with 117 control males and females without heart disease. Severe AS patients have statistically significant differences when compared with mild AS in ST-T wave depression during exercise, LVH on resting electrocardiogram, and echocardiogram. There was a significant difference in delta SBP between severe AS and normal controls (delta SBP 21.6 vs. 46.2 mmHg), and between moderate AS and normal controls (delta SBP 32 vs. 46.2 mmHg). There were no significant complications during maximal exercise testing. Children with echocardiographic severe and moderate AS have exercise testing abnormalities. Exercise test criteria for severity of AS were validated for echocardiographic criteria for AS severity.


Aortic stenosis; Cardiopulmonary exercise testing; Echocardiogram; Ischemia


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