Systolic and Diastolic Myocardial Response to Exercise in a Healthy Pediatric Cohort

Barbara Cifra, Luc Mertens, Moniba Mirkhani, Cameron Slorach, Wei Hui, Cedric Manlhiot, Mark K. Friedberg, Andreea Dragulescu

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background The aims of the present study were to evaluate the feasibility and reproducibility of color Doppler tissue imaging (DTI) and two-dimensional speckle-tracking echocardiography during semisupine cycle ergometric stress echocardiography and to establish normal myocardial systolic and diastolic left ventricular (LV) and right ventricular (RV) response to exercise in children. Methods This was a single-center prospective study of 62 healthy children (35 girls). The median age was 14 years (range, 8–19 years). A stepwise semisupine cycle ergometric protocol was used. Color DTI peak systolic (s′) and peak diastolic (e′) velocities and myocardial acceleration during isovolumic contraction were measured in the LV lateral wall, RV free wall, and septum. Early mitral inflow Doppler (E) was measured from the apical four-chamber view, and the ratio of diastolic filling to tissue early diastolic velocity (E/e′) was calculated. LV and RV longitudinal strain were measured from four-chamber apical views. LV circumferential strain was derived from the parasternal short-axis view at the midventricular level. The relationship of each parameter with increasing heart rate was evaluated at each stage of exercise. Results During exercise color DTI, velocities were obtained in 96% of subjects, with isovolumic contraction having the lowest feasibility among DTI measurements (89%). Strain analysis was measurable in 87% of subjects, with LV longitudinal strain measured in 98% of the subjects compared with 93% for circumferential strain. RV longitudinal strain had the lowest feasibility (70%). A linear relationship was observed between heart rate and color DTI velocities, E, E/e′, and myocardial longitudinal and circumferential strain. The relationship between isovolumic contraction and heart rate was exponential. Conclusions This study provides reference values for systolic and diastolic reserve during exercise in healthy children as measured by color DTI and two-dimensional speckle-tracking echocardiography. These data allow the evaluation of myocardial response in pediatric cardiac disease.

Original languageEnglish (US)
Pages (from-to)648-654
Number of pages7
JournalJournal of the American Society of Echocardiography
Issue number7
StatePublished - Jul 1 2016
Externally publishedYes


  • Children
  • Doppler tissue imaging
  • Exercise
  • Reference values
  • Speckle-tracking
  • Stress imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Systolic and Diastolic Myocardial Response to Exercise in a Healthy Pediatric Cohort'. Together they form a unique fingerprint.

Cite this