Limited utility of exercise stress tests in the evaluation of children with chest pain

Abstract

Objectives: The objective of this study was to assess the utility of the exercise stress test (EST) in pediatric patients without previously diagnosed heart disease who present with chest pain and to correlate EST results with echocardiographic findings.

Design: Retrospective chart review over a 14-month period.

Setting: Cardiology clinic at an academic children's hospital.

Patients: Two hundred three pediatric patients who presented to a pediatric cardiologist and had an EST for chest pain.

Outcome measures: Correlate EST results with echocardiographic findings and the patient's ultimate diagnosis.

Methods: Retrospective review of patients who presented to cardiology clinic for chest pain, analysis of medical records, EST, echocardiograms, and other downstream testing.

Results: Of 433 patients who presented to a pediatric cardiologist for chest pain, 203 (47%) had an EST performed. One hundred seventy-six (87%) patients did not have a prior diagnosis of congenital heart disease and made up our study population. Mean age was 13.2 ± 3 years. Of the patients who had an EST, 139 (79%) had chest pain with exercise. Echocardiography was performed in 124 (70%) of the patients who had an EST. Of patients undergoing echocardiography, 17/124 (14%) had abnormalities, but none of the abnormalities found were thought to contribute to the patients' chest pain. There were only four (2%) abnormal EST, and none were thought to be diagnostic for the patients' symptoms of chest pain. The most common diagnoses were musculoskeletal chest pain in 34 patients (19%) and reactive airway disease in 27 patients (15%).

Conclusion: In children referred to pediatric cardiology clinic for chest pain, EST has a low yield in identifying cardiac abnormalities.