Article Text

Download PDFPDF
Safety of maximal cardiopulmonary exercise testing in individuals with sickle cell disease: a systematic review
  1. Kellsey N Smith1,
  2. Tracy Baynard2,
  3. Peter S Fischbach3,
  4. Jane S Hankins4,
  5. Lewis L Hsu5,
  6. Peggy M Murphy1,
  7. Kiri K Ness6,
  8. Shlomit Radom-Aizik7,
  9. Amy Tang8,
  10. Robert I Liem1
  1. 1Division of Hematology, Oncology & Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  2. 2Integrative Physiology Laboratory, University of Illinois at Chicago, Chicago, Illinois, USA
  3. 3Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
  4. 4Department of Hematology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
  5. 5Division of Pediatric Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
  6. 6Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, USA
  7. 7Pediatric Exercise and Genomics Research Center, University of California Irvine, Irvine, California, USA
  8. 8Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
  1. Correspondence to Dr Robert I Liem, Division of Hematology, Oncology & Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; rliem{at}luriechildrens.org

Abstract

Objective We evaluated the safety of maximal cardiopulmonary exercise testing (CPET) in individuals with sickle cell disease (SCD). Maximal CPET using gas exchange analysis is the gold standard for measuring cardiopulmonary fitness in the laboratory, yet its safety in the SCD population is unclear.

Design Systematic review.

Data sources Systematic search of Medline (PubMed), EMBASE, Cochrane, ClinicalTrials.gov and professional society websites for all published studies and abstracts through December 2020.

Eligibility criteria for selecting studies Two reviewers independently extracted data of interest from studies that assessed safety outcomes of maximal CPET in children and adults with SCD. A modified version of the Newcastle-Ottawa Scale was used to assess for risk of bias in studies included.

Results In total, 24 studies met inclusion/exclusion criteria. Adverse events were reported separately or as part of study results in 36 (3.8%) of 939 participants with SCD undergoing maximal CPET in studies included. Most adverse events were related to transient ischaemic changes on ECG monitoring or oxygen desaturation during testing, which did not result in arrhythmias or other complications. Only 4 (0.43%) of 939 participants experienced pain events due to maximal CPET.

Conclusion Maximal CPET appears to be a safe testing modality in children and adults with SCD and can be used to better understand the physiological basis of reduced exercise capacity and guide exercise prescription in this population. Some studies did not focus on reporting adverse events related to exercise testing or failed to mention safety monitoring, which contributed to risk of bias.

  • exercise test
  • hematology
  • exercise physiology

Statistics from Altmetric.com

Footnotes

  • Contributors KS, PM and RL designed the study, analysed the data and wrote the manuscript. TB, PF, JH, LH, KK, SRA and AT helped to write the manuscript and critically provided edits of the manuscript.

  • Funding This work was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute (5R01HL136480) and the National Center for Advancing Translational Sciences (5U01TR002004).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.