What is the diagnostic value of the paediatric exercise tolerance test? Results from a UK centre

Purpose The aim of this study was to determine whether the exercise tolerance test can provide diagnostic and prognostic information regarding children and young adults and help predict outcome.

A total of 87 patients, aged 7-29 years (median 13, mean 13.4) were selected retrospectively. They underwent exercise test at the Freeman Hospital from December, 2015 to May, 2016. There were two groups of patients - 46 had symptoms such as chest pain, palpitations, syncope, or dyspnoea on exertion and no cardiac diagnosis, and 40 patients had a cardiac diagnosis such as hypertrophic cardiomyopathy, transposition of the great arteries with post-arterial switch operation, aortic stenosis or regurgitation, tetralogy of Fallot, abnormal coronary arteries, Wolff-Parkinson-White syndrome, or supraventricular tachycardia.

In the group of patients with symptoms and no cardiac diagnosis, exercise test was negative and there was no exercise-induced arrhythmia; 31 patients were discharged from follow-up. In the group of patients with a cardiac diagnosis, four patients had to be treated - one had ablation, one the Ross procedure, one aortic valve repair, and one aortic valve ballooning; in addition, seven patients had to be further investigated - one had signal average electrocardiogram, one stress cardiac MRI, two cardiac MRI, one lung function test, one reveal device, and one 24 hours electrocardiogram. In all, 43 patients were further followed-up from both groups.

The exercise tolerance test is useful for clinical decision making in children and young adults with a cardiac diagnosis. In this study, the exercise tolerance test in patients with symptoms suggestive of cardiac disease but no cardiac diagnosis did not reveal any new diagnoses.