Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Authors: EDWARDS, TIMOTHY - Arkansas Children'S Hospital; TAS, EMIR - University Arkansas For Medical Sciences (UAMS); LECLERC, KENNETH - Legacy Medical Group; BORSHEIM, ELISABET - University Arkansas For Medical Sciences (UAMS)

Submitted to: Frontiers in Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/23/2023
Publication Date: 4/6/2023
Citation: Edwards, T., Tas, E., Leclerc, K., Borsheim, E. 2023. Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents. Frontiers in Pediatrics. 11:1103094. https://doi.org/10.3389/fped.2023.1103094.
DOI: https://doi.org/10.3389/fped.2023.1103094

Interpretive Summary: Cardiovascular disease is often perceived as a problem for the older population, so cardiovascular health in adolescents is often neglected. Cardiopulmonary exercise testing (CPET; a fitness test) can be used to assess whether an individual has normal or abnormal heart and lung responses as the exercise load increases. This case report describes an abnormal CPET response suggestive of cardiac dysfunction in an asymptomatic adolescent that revealed a family history of early-age heart disease. A blood test showed increased level of an inflammatory marker which further suggested a health issue. Abnormal CPET responses in adolescents at-risk for heart disease should be taken seriously by healthcare providers to ensure a full clinical evaluation is performed. CPET measures over time might be important to perform in adolescents with strong family histories of heart disease, especially early-age heart disease.

Technical Abstract: Noninvasive cardiopulmonary exercise testing (CPET) provides the valuable capacity to analyze pulmonary gas exchange and cardiovascular responses that can be used to differentiate normal cardiopulmonary responses from abnormal. This case report highlights a proposed role for CPET in identifying potential cardiac pathologies in at-risk adolescents. An abnormal CPET response in an asymptomatic adolescent revealed a family history of early-age CAD. The significance of the abnormal CPET response was further supported by the presence of an elevated concentration of circulating high sensitivity C-reactive protein (hs-CRP). These findings emphasize the importance of a thorough clinical evaluation in at-risk adolescents, as CPET can aid in the early detection and management of cardiac pathologies, especially when combined with other relevant biomarkers such as plasma hs-CRP concentration, which can further suggest underlying pathology. Management considerations using serial CPET evaluations are recommended. Thus, CPET abnormalities combined with elevated hs-CRP should be taken seriously and provide justification for further evaluation and monitoring in adolescents at risk for cardiovascular disease.