Upright exercise stress echocardiography (SE) induces significant intraventricular gradient (IVG) and systolic anterior motion (SAM) in a large proportion of symptomatic athletes, who may therefore benefit from a negative inotropic therapy.

Background: Exercise stress echocardiography (ESE) is commonly employed in adults, but its applicability in pediatric populations remains to be clarified. Methods: A total of 309 consecutive children (C), with a mean age of 14.1 ± 2.6 years (range 6–17 years), underwent treadmill ESE starting in 2002. They were divided into two groups: Group I comprised 258 children, including 237 with symptoms related to exercise (such as chest pain, fatigue, lipothymia/syncope, or one aborted sudden death), 15 with electrocardiogram (ECG) abnormalities, and 6 with a positive ECG stress test showing ST changes. Group II consisted of 10 asymptomatic children whose parents requested routine screening, 11 with symptoms unrelated to exercise, 12 with a family history of sudden death, and 17 with known pathologies (including 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, and the remainder with various conditions, such as Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, and aortic switch operation). Regional wall motion abnormalities (RWMAs) and transvalvular or intraventricular (IVG) gradients were assessed using 2D and continuous-wave Doppler, respectively, in all cases. Results: The success rate was 100% (309/309). Stress-induced RWMAs were observed in two children. A significant IVG (>30 mmHg) was detected in 101 out of the 258 children (39%) in Group I, who presented with exercise-related symptoms, ECG abnormalities, or positive stress ECG. In Group I, the odds ratio (OR) of ESE reproducing the symptoms in children with IVG compared to those without IVG was 8.22 (95% CI: 4.84–13.99, p < 0.001). Conclusions: Treadmill ESE is both feasible and safe for pediatric populations. RWMAs demonstrated limited utility in our cohort of children, while IVG induced by exercise was frequently observed in symptomatic children.

Background: Treadmill exercise stress echocardiography (ESE) is both fea-sible and safe in the pediatric population. Although regional wall motion abnormalities (RWMA) have limited diagnostic utility, Doppler studies frequently demonstrate sig-nificant intraventricular pressure gradients (IVPGs) during exercise. These IVPGs, ob-served in 39% of 258 previously studied children, are absent at rest. Their detection provides valuable insight into exercise-related symptoms and abnormal findings on resting or stress electrocardiograms (ECGs). Purpose: To evaluate the effect of β-blocker therapy on the occurrence of intraventricular pressure gradients (IVPGs) in children presenting with symptoms or abnormal findings on resting or stress electrocardiograms (ECGs). Methods: Exercise stress echocardiography (ESE) was repeated in 66 of the 101 children who had developed intraventricular pressure gradients (IVPGs) during the initial assessment. All participants had normal resting echocardiograms and underwent follow-up evaluation while receiving β-blocker therapy. The study cohort included 15 females (23%) with a mean age of 14.6 ± 1.7 years (range: 11–17 years). Comprehensive two-dimensional and Doppler echocardiographic assessments were performed at baseline and during β-blocker treatment. Results: During the initial ESE, the mean in-traventricular pressure gradient (IVPG) was 105 ± 38 mmHg. Under β-blocker therapy, 37 children no longer developed IVPGs, while in the remaining 29 children, the IVPG was significantly reduced to a mean of 58 ± 32 mmHg (p < 0.0001). The mean heart rate at peak exercise decreased from 178 ± 15 bpm at baseline to 157 ± 9 bpm during the repeat ESE under β-blocker treatment (p < 0.0001). Clinical symptoms were reproduced in 47 children during the initial ESE but occurred in only 7 children during treatment (p < 0.0001). Conclusions: In children presenting with symptoms, abnormal resting or stress ECG findings, and exertional intraventricular pressure gradients (IVPGs), oral β-blocker therapy either prevented the occurrence of IVPGs or significantly reduced their severity. These hemodynamic improvements were associated with the resolution of clinical symptoms in 85% of the symptomatic cohort.

Background: Treadmill exercise stress echocardiography (ESE) is both feasible and safe in the pediatric population. Although regional wall motion abnormalities (RWMAs) have limited diagnostic utility, Doppler studies frequently demonstrate significant intraventricular pressure gradients (IVPGs) during exercise. These IVPGs, which were observed in 39% of 258 previously studied adolescents, are absent at rest. Their detection provides valuable insight into exercise-related symptoms and abnormal findings on resting or stress electrocardiograms (ECGs). Purpose: To evaluate the effect of β-blocker therapy on the occurrence of intraventricular pressure gradients (IVPGs) in adolescents presenting with symptoms or abnormal findings on resting or stress electrocardiograms (ECGs). Methods: Exercise stress echocardiography (ESE) was repeated in 66 of 101 adolescents who were found to have developed intraventricular pressure gradients (IVPGs) during the initial assessment. All participants had normal resting echocardiograms, and all underwent follow-up evaluation while receiving β-blocker therapy. The study cohort included 15 females (23%) and the mean age of participants was 14.6 ± 1.7 years (range: 11–17 years). Comprehensive two-dimensional and Doppler echocardiographic assessments were performed at baseline and during β-blocker treatment. Results: During the initial ESE, the mean intraventricular pressure gradient (IVPG) was 105 ± 38 mmHg. Under β-blocker therapy, 37 adolescents no longer developed IVPGs while, in the remaining 29 adolescents, the IVPG was significantly reduced to a mean of 58 ± 32 mmHg (p < 0.0001). The mean heart rate at peak exercise decreased from 178 ± 15 bpm at baseline to 157 ± 9 bpm during the repeat ESE under β-blocker treatment (p < 0.0001). Clinical symptoms were reproduced in forty-seven adolescents during the initial ESE, but occurred in only seven adolescents during treatment (p < 0.0001). Conclusions: In adolescents presenting with symptoms or abnormal resting or stress ECG findings, and exertional intraventricular pressure gradients (IVPGs), oral β-blocker therapy either prevented the occurrence of IVPGs or significantly reduced their severity. These hemodynamic improvements were associated with the resolution of clinical symptoms in 85% of the symptomatic cohort.