The Utility of Cardiopulmonary Exercise Testing for the Prediction of Outcomes in Ambulatory Children with Dilated Cardiomyopathy

Ching Kit Chen, Cedric Manlhiot, Jennifer L. Russell, Paul F. Kantor, Brian W. McCrindle, Jennifer Conway

Research output: Contribution to journalArticle

Abstract

Background Unlike adult patients, the utility of cardiopulmonary exercise testing (CPET) in children as a prognostic tool is unclear. We sought to examine the associations of CPET with outcomes in children with dilated cardiomyopathy (DCM). Methods This was a single-center, retrospective review of children with DCM who underwent CPET. The primary endpoint for this study was a time-dependent composite outcome of hospitalization for management of decompensated heart failure, initiation of mechanical circulatory support, heart transplant, or death. Results We examined 52 children with DCM who underwent CPET at median age 12.6 years (interquartile range [IQR], 9.9-14.6 years). At first CPET, the median peak heart rate was 80% (IQR, 70-88%) of predicted, median peak oxygen consumption 62% (IQR, 45-77%) of predicted, and median minute ventilation/carbon dioxide production slope 34.9 (IQR, 27.9-39.4). Eighteen (35%) patients reached the composite outcome during follow-up. Univariable factors associated with the composite outcome included: Lower peak heart rate predicted, lower blood pressure response, lower peak oxygen consumption predicted, and higher minute ventilation/carbon dioxide production slope. The association between exercise performance and composite outcome was linear; thus, no reliable cutoff point could be identified. Serial CPET had been performed in 30 patients; clinically, those with deterioration of exercise capacity had poorer outcomes. Conclusions Cardiopulmonary exercise testing is feasible in children with DCM and is useful to predict outcomes. The finding of lower exercise capacity and lower blood pressure response should prompt closer follow-up. In those with serial testing, a decline in exercise capacity may be a marker of clinical deterioration.

Original languageEnglish (US)
Pages (from-to)2455-2460
Number of pages6
JournalTransplantation
Volume101
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Fingerprint

Dilated Cardiomyopathy
Exercise
Carbon Dioxide
Oxygen Consumption
Ventilation
Heart Rate
Blood Pressure
Hospitalization
Heart Failure
Biomarkers
Transplants

ASJC Scopus subject areas

  • Transplantation

Cite this

The Utility of Cardiopulmonary Exercise Testing for the Prediction of Outcomes in Ambulatory Children with Dilated Cardiomyopathy. / Chen, Ching Kit; Manlhiot, Cedric; Russell, Jennifer L.; Kantor, Paul F.; McCrindle, Brian W.; Conway, Jennifer.

In: Transplantation, Vol. 101, No. 10, 01.10.2017, p. 2455-2460.

Research output: Contribution to journalArticle

Chen, Ching Kit ; Manlhiot, Cedric ; Russell, Jennifer L. ; Kantor, Paul F. ; McCrindle, Brian W. ; Conway, Jennifer. / The Utility of Cardiopulmonary Exercise Testing for the Prediction of Outcomes in Ambulatory Children with Dilated Cardiomyopathy. In: Transplantation. 2017 ; Vol. 101, No. 10. pp. 2455-2460.
@article{f2db41cc507d4ab38127171142abcf96,
title = "The Utility of Cardiopulmonary Exercise Testing for the Prediction of Outcomes in Ambulatory Children with Dilated Cardiomyopathy",
abstract = "Background Unlike adult patients, the utility of cardiopulmonary exercise testing (CPET) in children as a prognostic tool is unclear. We sought to examine the associations of CPET with outcomes in children with dilated cardiomyopathy (DCM). Methods This was a single-center, retrospective review of children with DCM who underwent CPET. The primary endpoint for this study was a time-dependent composite outcome of hospitalization for management of decompensated heart failure, initiation of mechanical circulatory support, heart transplant, or death. Results We examined 52 children with DCM who underwent CPET at median age 12.6 years (interquartile range [IQR], 9.9-14.6 years). At first CPET, the median peak heart rate was 80{\%} (IQR, 70-88{\%}) of predicted, median peak oxygen consumption 62{\%} (IQR, 45-77{\%}) of predicted, and median minute ventilation/carbon dioxide production slope 34.9 (IQR, 27.9-39.4). Eighteen (35{\%}) patients reached the composite outcome during follow-up. Univariable factors associated with the composite outcome included: Lower peak heart rate predicted, lower blood pressure response, lower peak oxygen consumption predicted, and higher minute ventilation/carbon dioxide production slope. The association between exercise performance and composite outcome was linear; thus, no reliable cutoff point could be identified. Serial CPET had been performed in 30 patients; clinically, those with deterioration of exercise capacity had poorer outcomes. Conclusions Cardiopulmonary exercise testing is feasible in children with DCM and is useful to predict outcomes. The finding of lower exercise capacity and lower blood pressure response should prompt closer follow-up. In those with serial testing, a decline in exercise capacity may be a marker of clinical deterioration.",
author = "Chen, {Ching Kit} and Cedric Manlhiot and Russell, {Jennifer L.} and Kantor, {Paul F.} and McCrindle, {Brian W.} and Jennifer Conway",
year = "2017",
month = "10",
day = "1",
doi = "10.1097/TP.0000000000001672",
language = "English (US)",
volume = "101",
pages = "2455--2460",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - The Utility of Cardiopulmonary Exercise Testing for the Prediction of Outcomes in Ambulatory Children with Dilated Cardiomyopathy

AU - Chen, Ching Kit

AU - Manlhiot, Cedric

AU - Russell, Jennifer L.

AU - Kantor, Paul F.

AU - McCrindle, Brian W.

AU - Conway, Jennifer

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Unlike adult patients, the utility of cardiopulmonary exercise testing (CPET) in children as a prognostic tool is unclear. We sought to examine the associations of CPET with outcomes in children with dilated cardiomyopathy (DCM). Methods This was a single-center, retrospective review of children with DCM who underwent CPET. The primary endpoint for this study was a time-dependent composite outcome of hospitalization for management of decompensated heart failure, initiation of mechanical circulatory support, heart transplant, or death. Results We examined 52 children with DCM who underwent CPET at median age 12.6 years (interquartile range [IQR], 9.9-14.6 years). At first CPET, the median peak heart rate was 80% (IQR, 70-88%) of predicted, median peak oxygen consumption 62% (IQR, 45-77%) of predicted, and median minute ventilation/carbon dioxide production slope 34.9 (IQR, 27.9-39.4). Eighteen (35%) patients reached the composite outcome during follow-up. Univariable factors associated with the composite outcome included: Lower peak heart rate predicted, lower blood pressure response, lower peak oxygen consumption predicted, and higher minute ventilation/carbon dioxide production slope. The association between exercise performance and composite outcome was linear; thus, no reliable cutoff point could be identified. Serial CPET had been performed in 30 patients; clinically, those with deterioration of exercise capacity had poorer outcomes. Conclusions Cardiopulmonary exercise testing is feasible in children with DCM and is useful to predict outcomes. The finding of lower exercise capacity and lower blood pressure response should prompt closer follow-up. In those with serial testing, a decline in exercise capacity may be a marker of clinical deterioration.

AB - Background Unlike adult patients, the utility of cardiopulmonary exercise testing (CPET) in children as a prognostic tool is unclear. We sought to examine the associations of CPET with outcomes in children with dilated cardiomyopathy (DCM). Methods This was a single-center, retrospective review of children with DCM who underwent CPET. The primary endpoint for this study was a time-dependent composite outcome of hospitalization for management of decompensated heart failure, initiation of mechanical circulatory support, heart transplant, or death. Results We examined 52 children with DCM who underwent CPET at median age 12.6 years (interquartile range [IQR], 9.9-14.6 years). At first CPET, the median peak heart rate was 80% (IQR, 70-88%) of predicted, median peak oxygen consumption 62% (IQR, 45-77%) of predicted, and median minute ventilation/carbon dioxide production slope 34.9 (IQR, 27.9-39.4). Eighteen (35%) patients reached the composite outcome during follow-up. Univariable factors associated with the composite outcome included: Lower peak heart rate predicted, lower blood pressure response, lower peak oxygen consumption predicted, and higher minute ventilation/carbon dioxide production slope. The association between exercise performance and composite outcome was linear; thus, no reliable cutoff point could be identified. Serial CPET had been performed in 30 patients; clinically, those with deterioration of exercise capacity had poorer outcomes. Conclusions Cardiopulmonary exercise testing is feasible in children with DCM and is useful to predict outcomes. The finding of lower exercise capacity and lower blood pressure response should prompt closer follow-up. In those with serial testing, a decline in exercise capacity may be a marker of clinical deterioration.

UR - http://www.scopus.com/inward/record.url?scp=85011317607&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011317607&partnerID=8YFLogxK

U2 - 10.1097/TP.0000000000001672

DO - 10.1097/TP.0000000000001672

M3 - Article

C2 - 28145997

AN - SCOPUS:85011317607

VL - 101

SP - 2455

EP - 2460

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 10

ER -