Data on maximal exercise-stress-testing (m-EST) in anomalous-aortic-origin-of-coronary-arteries
(AAOCA) is limited and correlation with stress perfusion imaging has not been demonstrated.
AAOCA patients ≤20 years were prospectively enrolled from 6/2014-01/2020. A m-EST
was defined as heart rate >85%ile on ECG-EST and respiratory-exchange-ratio ≥1.05
on cardiopulmonary-exercise-testing (CPET). Abnormal m-EST included significant ST-changes
or high-grade arrhythmia, V̇O2max and/or O2 pulse <85% predicted, or abnormal O2 pulse curve. A (+) dobutamine-stress cardiac-magnetic-resonance-imaging (+DS-CMR)
had findings of inducible-ischemia. Outcomes: (1) Differences in m-EST based on AAOCA-type; (2) Assuming DS-CMR as gold-standard
for detection of inducible ischemia, determine agreement between m-EST and DS-CMR.
A total of 155 AAOCA (right, AAORCA = 126; left, AAOLCA = 29) patients with a median
(IQR) age of 13 (11–15) years were included; 63% were males and a m-EST was completed
in 138 (89%). AAORCA and AAOLCA had similar demographic and m-EST characteristics,
although AAOLCA had more frequently evidence of inducible ischemia on m-EST (P = 0.006) and DS-CMR (P = 0.007). Abnormal O2 pulse was significantly associated with +DS-CMR (OR 5.3, 95% CI 1.6-18, P = 0.005). Sensitivity was increased with addition of CPET to ECG-EST (to 58% from 19%).
There was no agreement between m-EST and DS-CMR for detection of inducible ischemia.
A m-EST has very low sensitivity for detection of inducible ischemia in AAOCA, and
sensitivity is increased with addition of CPET. Stress perfusion abnormalities on
DS-CMR were not concordant with m-EST findings and adjunctive testing should be considered
for clinical decision making in AAOCA.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AAOCA (anomalous aortic origin of a coronary artery (right AAORCA left AAOLCA)), CPET (cardiopulmonary exercise stress test), DS-CMR (dobutamine stress-cardiac magnetic resonance imaging), ECG-EST (electrocardiographic evaluation of exercise stress test), LAD (left anterior descending), m-EST (maximal-exercise stress test), O2 pulse (oxygen pulse), RER (respiratory exchange ratio), VAT (ventilatory anaerobic threshold), V̇E/V̇CO2 (minute ventilation/carbon dioxide production), V̇O2 (maximal oxygen uptake)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 26, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
The authors have no conflicts of interest to declare. Dr Carlos M Mery reports Grant from PCORI to the institution (PI) and Honoraria from national societies - not applicable to current work.
IRB #: H-43968; Date of approval: 08/01/2018
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