Feasibility of Noninvasive Diastolic Stress Testing in the 10- to 21-Year-Old Age Group

ABSTRACT Background A subset of adult patients with heart failure symptoms and normal left ventricular systolic function have primary left ventricular diastolic dysfunction with elevated filling pressure. Noninvasive diastolic stress testing (NDST) has been used in adults to reveal left ventricular diastolic dysfunction during exercise. Given limited data in young individuals, we assessed the feasibility and reliability of NDST in a diverse sample of 10- to 21-year-olds. Methods Twenty-two participants with a normal cardiac evaluation from our Le Bonheur Children’s Hospital Heart Institute outpatient center were recruited for the study protocol. After consent and screening, 1 study participant was ineligible (obesity), leaving 21 patients. Baseline echocardiograms were performed at rest and as part of a graduated exercise stress test at 10, 20, and 30 W using a semirecumbent cycle ergometer. Conventional exercise data, baseline echocardiogram data, and left ventricular diastolic parameters were obtained. Left ventricular diastolic parameters were measured during each exercise stage and at 5- and 10-minute recovery. Two blinded readers (pediatric cardiologists) reviewed the echocardiograms to determine interobserver variability. Results Mean age and body mass index were 15.3 ± 3 years and 21.2 ± 3.1 kg · m −2 , respectively. There was 81% agreement between readers with a Cohen κ coefficient of 0.44 (moderate agreement). The mitral E/e′ remained normal during exercise and recovery. Conclusion NDST is a feasible and reliable technique in a diverse sample in the 10- to 21-year-old age range.