Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening

被引：27

作者：

Sawada, Hirofumi ^{[1
]}

Mitani, Yoshihide ^{[1
]}

Nakayama, Tomotaka ^{[2
]}

Fukushima, Hiroyuki ^{[3
]}

Kogaki, Shigetoyo ^{[4
]}

Igarashi, Takehiro ^{[5
]}

Ichida, Fukiko ^{[6
]}

Ono, Yasuo ^{[7
]}

Nakanishi, Toshio ^{[8
]}

Doi, Shozaburo ^{[9
]}

Ishikawa, Shiro ^{[10
]}

Matsushima, Masaki ^{[11
]}

Yamada, Osamu ^{[5
]}

Saji, Tsutomu ^{[2
]}

机构：

[1] Mie Univ, Dept Pediat, Sch Med, Tsu, Mie, Japan

[2] Toho Univ, Dept Pediat, Omori Med Ctr, Tokyo, Japan

[3] Keio Univ, Dept Pediat, Sch Med, Tokyo, Japan

[4] Osaka Univ, Dept Pediat, Sch Med, Osaka, Japan

[5] Natl Cerebral & Cardiovasc Ctr, Dept Pediat Cardiol, Osaka, Japan

[6] Toyama Univ, Dept Pediat, Sch Med, Toyama, Japan

[7] Shizuoka Childrens Hosp, Dept Cardiol, Shizuoka, Japan

[8] Tokyo Womens Med Univ, Dept Pediat Cardiol, Tokyo, Japan

[9] Tokyo Med & Dent Univ, Dept Pediat, Tokyo, Japan

[10] Fukuoka Childrens Hosp, Dept Pediat Cardiol, Fukuoka, Fukuoka, Japan

[11] Social Insurance Chukyo Hosp, Dept Pediat Cardiol, Nagoya, Aichi, Japan

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2019年 / 199卷 / 11期

关键词：

pediatrics; hypertension; pulmonary; electrocardiography; mass screening; HEALTHY GENERAL POPULATIONS; PEOPLE; 12-25; YEARS; SYSTEMIC-SCLEROSIS; CARDIOVASCULAR-DISEASE; CLINICAL-FEATURES; CHILDREN; SURVIVAL; PREVENTION; SECONDARY; PERIOD;

D O I：

10.1164/rccm.201802-0375OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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 nansions (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.m(2); 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.

引用

页码：1397 / 1406

页数：10

共 48 条

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