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A SYSTEMATIC REVIEW OF THE REFERENCE VALUES IN PEDIATRIC CARDIOPULMONARY EXERCISE TESTING
S188 RESULTS:
We enrolled 181 subjects of which 53% were under 12 months of age. Length of hospital admission ranged greatly; 54% were admitted for 7 days or less and 8% were admitted for >4 weeks. The most common diagnoses were ventricular septal defect (n¼39), atrial septal defect (n¼28), and coarctation of the aorta (n¼20). Home enteral feeding was required in 21 (12%) of children at discharge and 167 (92%) were discharged on medications. One hundred and seventy-three parents (96%) felt they were ready to take their child home as planned. Parents rated their knowledge on a scale of 0-10 in a number of categories. In most categories (medical needs, problems to watch for, who and when to call, what their child was allowed and not allowed to do, and knowledge about what happens next in follow up) greater than 90% of respondents rated their knowledge 8 or higher. In contrast, only 68% of respondents rated 8 or higher in knowledge regarding services and information available in their community. Fourteen parents (8%) didn’t know whether their child had had cardiac surgery during the hospitalization. CONCLUSION: Most parents feel ready to go home at the time of discharge. The multidisciplinary team needs to implement change to ensure families are aware of services in their community if any exist. Further study is required to determine which factors identify parents that need additional support and education prior to their child’s discharge.
Canadian Journal of Cardiology Volume 30 2014
investigators. Exercise protocols were very heterogeneous. Thirteen studies (48%) were performed on a cycle ergometer, 14 studies used a treadmill and one study used both. A total of 17 different exercise protocols were used. Among the 15 articles proposing reference values, simple linear regression was the most frequently used normalization method to account for body size (53.3%). CPET measurements were usually sexspecific and normalized for only one variable (age, weight, height, or body surface area). None of the articles mentioned any attempt at detecting residual association, heteroscedasticity or departure from the normal distribution. An example of heterogeneity of results is presented in figure 1. It shows peak VO2 indexed for weight and stratified for age that was reported in four studies. Important variation was observed, especially for boys between 7 and 9 years of age, for whom predicted peak VO2 ranged from 38 to 58 ml/min/kg. CONCLUSION: This systematic literature review identified important heterogeneity in exercise protocols and normalization strategies in pediatric CPET reference values. Disparity in reported predicted values is likely due to variation in exercise protocols, incomplete adjustment for body size and incomplete validation. There is a great need to establish validated CPET reference values on a large healthy pediatric population by using a sound parametric modeling approach that takes into account all relevant body size parameters.
260 A SYSTEMATIC REVIEW OF THE REFERENCE VALUES IN PEDIATRIC CARDIOPULMONARY EXERCISE TESTING S Blais, J Berbari, F Dallaire Sherbrooke, Québec BACKGROUND:
Exercise-induced cardiovascular stress has the potential to unmask ventricular dysfunction that is not apparent at rest. In congenital heart disease, cardiopulmonary exercise testing (CPET) is increasingly being used for prognosis and identification of impaired functional capacity. Maximal and submaximal exercise parameters have been under-studied in children and adolescents. Some authors have published reference values for pediatric CPET, but evaluation of their validity is lacking. The aim of this study was to systematically review all articles reporting pediatric CPET reference values. METHODS AND RESULTS: Articles published between 1980 and 2013 that proposed references values were reviewed. We abstracted information on populations studied, reported exercise parameters, normalization Methods and exercise protocols. Out of 1263 articles identified by the search strategy, 28 met the inclusion criteria. Of them, 15 studies specifically aimed to establish CPET reference values while the remaining 13 articles presented results for a healthy control group without proposing reference values per se. Peak VO2 was the most studied parameter. Most maximal and submaximal measurements were studied but some of them by only a few
261 MEDICAL FACTORS ASSOCIATED WITH MODERATE-TOVIGOROUS PHYSICAL ACTIVITY IN CHILDREN WITH CONGENITAL HEART DISEASE MAY BE SPECIFIC TO THE UNDERLYING LESION L Banks, S Rosenthal, PE Longmuir, C Manlhiot, A McKillop, BW McCrindle Toronto, Ontario BACKGROUND:
Moderate-to-vigorous physical activity (MVPA) can vary significantly between congenital heart disease (CHD) patients and have important long-term health implications. The study sought to determine the medical factors associated with MVPA, and if those associations are influenced by type of CHD. METHODS: Medical history was abstracted from chart review. Omni-directional accelerometers assessed 7-day MVPA levels. Multivariable regression analysis (backward selection) was
We enrolled 181 subjects of which 53% were under 12 months of age. Length of hospital admission ranged greatly; 54% were admitted for 7 days or less and 8% were admitted for >4 weeks. The most common diagnoses were ventricular septal defect (n¼39), atrial septal defect (n¼28), and coarctation of the aorta (n¼20). Home enteral feeding was required in 21 (12%) of children at discharge and 167 (92%) were discharged on medications. One hundred and seventy-three parents (96%) felt they were ready to take their child home as planned. Parents rated their knowledge on a scale of 0-10 in a number of categories. In most categories (medical needs, problems to watch for, who and when to call, what their child was allowed and not allowed to do, and knowledge about what happens next in follow up) greater than 90% of respondents rated their knowledge 8 or higher. In contrast, only 68% of respondents rated 8 or higher in knowledge regarding services and information available in their community. Fourteen parents (8%) didn’t know whether their child had had cardiac surgery during the hospitalization. CONCLUSION: Most parents feel ready to go home at the time of discharge. The multidisciplinary team needs to implement change to ensure families are aware of services in their community if any exist. Further study is required to determine which factors identify parents that need additional support and education prior to their child’s discharge.
Canadian Journal of Cardiology Volume 30 2014
investigators. Exercise protocols were very heterogeneous. Thirteen studies (48%) were performed on a cycle ergometer, 14 studies used a treadmill and one study used both. A total of 17 different exercise protocols were used. Among the 15 articles proposing reference values, simple linear regression was the most frequently used normalization method to account for body size (53.3%). CPET measurements were usually sexspecific and normalized for only one variable (age, weight, height, or body surface area). None of the articles mentioned any attempt at detecting residual association, heteroscedasticity or departure from the normal distribution. An example of heterogeneity of results is presented in figure 1. It shows peak VO2 indexed for weight and stratified for age that was reported in four studies. Important variation was observed, especially for boys between 7 and 9 years of age, for whom predicted peak VO2 ranged from 38 to 58 ml/min/kg. CONCLUSION: This systematic literature review identified important heterogeneity in exercise protocols and normalization strategies in pediatric CPET reference values. Disparity in reported predicted values is likely due to variation in exercise protocols, incomplete adjustment for body size and incomplete validation. There is a great need to establish validated CPET reference values on a large healthy pediatric population by using a sound parametric modeling approach that takes into account all relevant body size parameters.
260 A SYSTEMATIC REVIEW OF THE REFERENCE VALUES IN PEDIATRIC CARDIOPULMONARY EXERCISE TESTING S Blais, J Berbari, F Dallaire Sherbrooke, Québec BACKGROUND:
Exercise-induced cardiovascular stress has the potential to unmask ventricular dysfunction that is not apparent at rest. In congenital heart disease, cardiopulmonary exercise testing (CPET) is increasingly being used for prognosis and identification of impaired functional capacity. Maximal and submaximal exercise parameters have been under-studied in children and adolescents. Some authors have published reference values for pediatric CPET, but evaluation of their validity is lacking. The aim of this study was to systematically review all articles reporting pediatric CPET reference values. METHODS AND RESULTS: Articles published between 1980 and 2013 that proposed references values were reviewed. We abstracted information on populations studied, reported exercise parameters, normalization Methods and exercise protocols. Out of 1263 articles identified by the search strategy, 28 met the inclusion criteria. Of them, 15 studies specifically aimed to establish CPET reference values while the remaining 13 articles presented results for a healthy control group without proposing reference values per se. Peak VO2 was the most studied parameter. Most maximal and submaximal measurements were studied but some of them by only a few
261 MEDICAL FACTORS ASSOCIATED WITH MODERATE-TOVIGOROUS PHYSICAL ACTIVITY IN CHILDREN WITH CONGENITAL HEART DISEASE MAY BE SPECIFIC TO THE UNDERLYING LESION L Banks, S Rosenthal, PE Longmuir, C Manlhiot, A McKillop, BW McCrindle Toronto, Ontario BACKGROUND:
Moderate-to-vigorous physical activity (MVPA) can vary significantly between congenital heart disease (CHD) patients and have important long-term health implications. The study sought to determine the medical factors associated with MVPA, and if those associations are influenced by type of CHD. METHODS: Medical history was abstracted from chart review. Omni-directional accelerometers assessed 7-day MVPA levels. Multivariable regression analysis (backward selection) was