@Article{chd.12681,
AUTHOR = {Soham Dasgupta, Megan Stark, Sonal Bhatt, Peter Fischbach, Shriprasad Deshpande},
TITLE = {The utility of combined cardiopulmonary exercise stress testing in the evaluation of pediatric patients with chest pain},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {1058--1063},
URL = {http://www.techscience.com/schd/v13n6/39089},
ISSN = {3071-1738},
ABSTRACT = {<b>Introduction:</b> A cardiac cause is an extremely rare etiology of pediatric chest pain. 
Despite its low sensitivity/specificity, exercise stress testing (EST) is widely used to 
determine the prognosis in patients with suspected/established coronary disease. 
We aimed to look at the utility of a combined cardiopulmonary EST in the evaluation 
of pediatric patients with chest pain.<br/>
<b>Methods:</b> After institutional review board approval, a retrospective chart review was 
performed of all pediatric patients who were referred for an EST for chest pain from 
January 2014 to 2017. Patients with incomplete records, severe congenital heart disease, and a prior EST were excluded.<br/>
<b>Results:</b> A total of 389 patients met the inclusion criteria. Echocardiogram (ECHO) 
was performed on 333 (85.6%) patients and 43 (11%) previously unknown structural 
cardiac anomalies were identified. A total of 76 (19.5%) patients had an abnormal EST 
with the 3 most common causes being related to the respiratory system. Only four 
patients had both an abnormal exercise stress test and an incidental structural anomaly on ECHO but none of them had their symptoms recreated during the EST.<br/>
<b>Conclusion:</b> Only 1% of patients previously undiagnosed with heart disease had an 
abnormal stress test and an incidental anomaly on ECHO. These ECHO anomalies 
were unlikely to be the cause of chest pain. Furthermore, since the majority of abnormal stress tests were secondary to a pulmonary cause, a complete cardiopulmonary 
EST may be an effective screening tool for certain patients presenting with chest 
pain. Our study emphasizes the need for performing a complete cardiopulmonary 
EST instead of an isolated cardiac stress test to maximize diagnostic efficiency and 
yield.},
DOI = {10.1111/chd.12681}
}