Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening.
Am J Respir Crit Care Med
; 199(11): 1397-1406, 2019 06 01.
Article
en En
| MEDLINE
| ID: mdl-30428270
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 MainResults:
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 â 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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Servicios de Salud Escolar
/
Tamizaje Masivo
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Diagnóstico Precoz
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Electrocardiografía
/
Hipertensión Pulmonar Primaria Familiar
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
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Screening_studies
Límite:
Adolescent
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Child
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Child, preschool
/
Female
/
Humans
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Infant
/
Male
País/Región como asunto:
Asia
Idioma:
En
Revista:
Am J Respir Crit Care Med
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Japón