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Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening
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Journal Article
Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening
2019
Overview
Abstract
Rationale
To detect pulmonary arterial hypertension (PAH) at any early stage is a promising approach to optimize the outcome.
Objectives
To investigate the impact of school ECG-based screening on detecting idiopathic or heritable (I/H)-PAH in the general pediatric population.
Methods
This was a nationwide survey of patients with I/H-PAH newly diagnosed at 3 months to 18 years of age in Japan during 2005–2012.
Measurements and Main Results
Eighty-seven eligible patients (age range, 1–16 yr) were recruited. Among 68 (78%) patients diagnosed at greater than or equal to 6 years of age (the age of the first ECG-based screening), 28 (41%) were detected by the ECG-based screening (screening group) and 40 (59%) were recognized by their symptoms (n = 37) or coincidental occasions (n = 3; nonscreening group). In the screening group, the proportion of patients in World Health Organization functional class I/II at diagnosis was higher (96% vs. 60%; P < 0.001), plasma brain natriuretic peptide level was lower (149 ± 290 vs. 398 ± 559 pg/ml; P = 0.045), and 6-minute-walk distance was longer (420 ± 109 vs. 327 ± 104 m; P < 0.001) than the nonscreening group, despite similar values in mean pulmonary artery pressure (58 ± 17 vs. 61 ± 17 mm Hg; P = 0.42) and pulmonary vascular resistance index (18 ± 8 vs. 21 ± 11 Wood units ⋅ m2; P = 0.24) between groups. The proportion of patients on intravenous epoprostenol at the final visit was lower in the screening group than the nonscreening group (14% vs. 50; P = 0.004).
Conclusions
These findings suggest that the ECG-based screening detects a unique subpopulation of pediatric patients with I/H-PAH that is associated with already established pulmonary hypertension but without obvious right heart failure and warrants investigating the prognostic significance of this system.
Publisher
Oxford University Press
Subject
/ Age
/ Child
/ Councils
/ Electrocardiography - methods
/ Familial Primary Pulmonary Hypertension - diagnosis
/ Female
/ Genomics
/ Humans
/ Infant
/ Japan
/ Male
/ Mass Screening - statistics & numerical data
/ Medicine
/ School Health Services - statistics & numerical data
/ Schools
/ Society
/ Students
