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Published on: April 19, 2019
Physical exercise and cardiovascular response: design and implementation of a pediatric CMR cohort study
Meddy N Bongers-Karmaoui1,2, Alexander Hirsch3,4, Ricardo P J Budde4
1The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Insights
This study shows that isometric handgrip exercise is a feasible Cardiovascular Magnetic Resonance (CMR) test for children, revealing significant cardiovascular responses and offering new ways to assess pediatric heart health.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Exercise Physiology
Background:
- Assessing pediatric cardiovascular health requires reliable and reproducible methods.
- Cardiovascular Magnetic Resonance (CMR) offers detailed anatomical and functional insights.
- Evaluating the cardiovascular response to exercise in children is crucial for understanding heart function.
Purpose of the Study:
- To determine the feasibility and reproducibility of an isometric handgrip exercise test during CMR in a pediatric population.
- To evaluate the cardiovascular response, including hemodynamic and volumetric changes, to isometric handgrip exercise in healthy children.
- To explore the potential of CMR-based exercise testing for detecting subtle differences in pediatric cardiovascular health.
Main Methods:
- A subgroup of 207 children (mean age 16 years) from a population-based cohort underwent isometric handgrip exercise during CMR.
- Continuous heart rate and blood pressure were monitored at rest and during exercise.
- CMR assessed left ventricular mass, aortic distensibility, pulse wave velocity, volumes, ejection fraction, stroke volume, and cardiac output.
Main Results:
- The isometric handgrip exercise was feasible and reproducible in children during CMR.
- Significant increases in heart rate (42.6%) and blood pressure (systolic 6.4%, diastolic 5.4%, mean 11.0%) were observed during exercise.
- Left ventricular end-diastolic/end-systolic volumes and cardiac output increased, while ejection fraction slightly decreased (p < 0.05).
Conclusions:
- Sustained isometric handgrip exercise (7 min at 30-40% MVC) is a feasible and effective stressor during CMR in healthy children.
- This method elicits significant cardiovascular and left ventricular functional changes, demonstrating its utility.
- CMR-based handgrip exercise testing presents novel opportunities for early detection of cardiovascular health differences in pediatrics.
Abstract:
To examine feasibility and reproducibility and to evaluate the cardiovascular response to an isometric handgrip exercise in low-risk pediatric population using Cardiovascular Magnetic Resonance measurements. In a subgroup of 207 children with a mean age of 16 years participating in a population-based prospective cohort study, children performed an isometric handgrip exercise. During rest and exercise, continuous heart rate and blood pressure were measured. Cardiovascular magnetic resonance (CMR) measurements included left ventricular mass, aortic distensibility and pulse wave velocity at rest and left ventricular end-diastolic and end-systolic volumes, ejection fraction, stroke volume and cardiac output during rest and exercise. 207 children had successful CMR measurements in rest and 184 during exercise. We observed good reproducibility for all cardiac measurements. Heart rate increased with a mean ± standard deviation of 42.6% ± 20.0 and blood pressure with 6.4% ± 7.0, 5.4% ± 6.1 and 11.0% ± 8.3 for systolic, diastolic and mean arterial blood pressure respectively (p-values < 0.05). During exercise, left ventricular end-diastolic and end-systolic volumes and cardiac output increased, whereas left ventricular ejection fraction slightly decreased (p-values < 0.05). Stroke volume did not change significantly. A sustained handgrip exercise of 7 min at 30-40% maximal voluntary contraction is a feasible exercise-test during CMR in a healthy pediatric population, which leads to significant changes in heart rate, blood pressure and functional measurements of the left ventricle in response to exercise. This approach offers great novel opportunities to detect subtle differences in cardiovascular health.
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