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Monitoring beta-blocker therapy in adolescents with exercise-induced intraventricular gradients using exercise stress echocardiography

2025-08-21Research article Open access
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dc.contributor.authorCotrim, Nuno
dc.contributor.authorCafé, Hugo M.
dc.contributor.authorGuardado, Jorge
dc.contributor.authorCordeiro, Pedro
dc.contributor.authorMartins, Rui
dc.contributor.authorCotrim, Hortense
dc.contributor.authorCotrim, Carlos
dc.date.accessioned2025-09-12T07:39:17Z
dc.date.available2025-09-12T07:39:17Z
dc.date.issued2025-08-21
dc.description.abstractBackground: 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 ?-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 ?-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 ?-blocker treatment. Results: During the initial ESE, the mean intraventricular pressure gradient (IVPG) was 105 ± 38 mmHg. Under ?-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 ?-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 ?-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.eng
dc.identifier.citationCotrim, N., Café, H. M., Guardado, J., & Cordeiro, P. et al. (2025). Monitoring beta-blocker therapy in adolescents with exercise-induced intraventricular gradients using exercise stress echocardiography. Biomedicines, 13(8), Article 2035. https://doi.org/10.3390/biomedicines13082035
dc.identifier.doi10.3390/biomedicines13082035
dc.identifier.eid105014516057
dc.identifier.issn2227-9059
dc.identifier.other71b37c7a-1dbc-4293-a350-54441bccf87c
dc.identifier.pmid40868285
dc.identifier.urihttp://hdl.handle.net/10400.14/54809
dc.identifier.wos001559776900001
dc.language.isoeng
dc.peerreviewedyes
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAdolescents
dc.subjectExercise stress echocardiography
dc.subjectIntraventricular pressure gradients
dc.subjectLung comets
dc.subjectPediatric cardiology
dc.subjectß-blockers
dc.titleMonitoring beta-blocker therapy in adolescents with exercise-induced intraventricular gradients using exercise stress echocardiographyeng
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.issue8
oaire.citation.titleBiomedicines
oaire.citation.volume13
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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