Abstract 876: Feasibility of a Four-Point Test to Screen for Cardiac Abnormalities in Asymptomatic At-Risk Children (Houston Early Age Risk Testing and Screening or HEARTS)
Background: Sudden cardiac arrest (SCA) in school age children is often related to underlying cardiac abnormalities. Because SCA occurs more often during exercise, preparticipation cardiac screening of athletic children has been proposed. With no standardized screening available, many children with such cardiac abnormalities are undiagnosed. Furthermore, a policy of screening athletic children precludes diagnosis of cardiac abnormalities in nonathletes, who are perhaps subselected out of athletic activities precisely because of an underlying cardiac condition. We hypothesized that a 20-minute screening test is feasible & can be administered to school age children to improve detection of cardiac abnormalities associated with SCA.
Methods: A cohort of sixth grade children underwent the four-point screening test. This involved a targeted History (Hx), focused physical exam (PE), 12-lead electrocardiogram (ECG), & targeted echocardiogram (ECHO). A standardized checklist was used for each stage, and all ECGs were evaluated per the European Society of Cardiology criteria. The ECHO comprised 20 views including coronary ostia evaluation.
Results: Of 150 eligible students, 94 (63%) assented to undergo the screening test. Mean age was 12 years (range 11–14), 57% female. The cohort was mainly African American (71%) & Hispanic (23%). Mean BMI was 22.6+/−5.7 sd (> 90th percentile), mean height=157.3+/−8.1 cm, & mean weight=56.3+/−17.3 kg. Mean blood pressure was 115/68+/−14/9 mmHg with 3 children having stage 2 hypertension, & left ventricular hypertrophy by ECG & ECHO. Seven (7.4%) of this asymptomatic cohort were diagnosed with an underlying heart condition: 2 major (aortic root dilatation, aortic coarctation) & 5 minor. Hx & PE correctly identified only one & ECG only 3 (43%); ECHO identified all 7 (100%) abnormalities. Four (4) cases of left ventricular hypertrophy by ECG were reclassified as physiologic hypertrophy “athletes heart” by ECHO.
Conclusion: A standardized four-point screening test applied to asymptomatic school aged children is feasible and can identify major & minor cardiac abnormalities, including newly diagnosed hypertension. ECHO was a critical element in diagnosing abnormalities & correcting ECG misdiagnoses.