ECG Screening Can Help Identify Cardiovascular Risks in Adolescents
A combination of screening methods, including electrocardiography (ECG), blood pressure and body mass index (BMI), can identify adolescents at risk for heart disease, according to a groundbreaking University of Miami Miller School of Medicine study led by Steven E. Lipshultz, M.D., professor of pediatrics, the George Batchelor Endowed Chair in Pediatric Cardiology, and Director of the Batchelor Children’s Research Institute.
After screening 600 students in grades 9-12 in seven metropolitan Tampa high schools, Lipshultz and his research team found 14 percent of the adolescents had borderline or abnormal ECGs – including two students whose ECG screenings indicated a heart problem that could lead to sudden cardiac death. In addition, nearly 40 percent of the students screened met the criteria for either systolic or diastolic prehypertension or hypertension, and 25 percent were classified as overweight or obese.
“The risk of premature cardiovascular disease during the teenage years, as indicated by an abnormal ECG, is much higher than anticipated,” said Lipshultz. “This shows the importance of large-scale screening to identify adolescents who appear healthy, but whose hearts may have already been adversely affected by obesity, high blood pressure and other problems. It is far more cost-effective to reduce cardiovascular risk factors in an adolescent than to wait 20 years and provide expensive emergency care to an adult after a heart attack.”
The Miller School study, “A High School-Based Voluntary Cardiovascular Risk Screening Program: Issues of Feasibility and Correlates of Electrocardiographic Outcomes,” was published March 18 in Pediatric Cardiology. Co-authors at the Miller School’s Department of Pediatrics were James D. Wilkinson, M.D., M.P.H.; David A. Ludwig, Ph.D.; William G. Harmon, M.D.; Robert O’Brien, M.S.; Mary C. Sokoloski, M.D.; Tracie L. Miller, M.D.; Sarah E. Messiah, Ph.D., M.P.H.; David C. Landy, Ph.D., M.P.H.; and Vivian I. Franco, M.P.H.
The Miller School’s comprehensive pediatric clinical research team at the Batchelor Children’s Research Institute worked closely for several years with All Children’s Hospital in St. Petersburg, which coordinated the Hillsborough County School District, foundations and others to set up the large-scale screening program. Three of the study’s co-authors – Gul H. Dadlani, M.D., who directed the study at All Children’s Hospital, Michael L. Epstein, M.D., and Jeffrey P. Jacobs, M.D. – are affiliated with All Children’s Hospital Heart Institute.
“This study is a good example of community participatory research,” said Lipshultz. “It shows how academic institutions can team with providers to find effective strategies for addressing the unique health issues facing Florida.”
In reviewing the screening factors, the Miller School researchers found that 31 percent of all teens had one risk factor for cardiovascular disease – an abnormal ECG, an elevated blood pressure or an elevated body mass index. In addition, 15 percent had two risk factors, and 4 percent had three risk factors.
“For teens with three risk factors, the prevalence of borderline or abnormal ECGs consistent with possible early heart disease was very concerning at 26.9 percent,” said Lipshultz. “This study suggests that there are a high number of teens with cardiovascular abnormalities who could benefit from counseling and interventions to reduce the risk of future heart problems.”
Overall, 50 percent of the screened students had one or more abnormal risk factors for premature cardiovascular disease. However, when BMI and blood pressure results were both normal, there was a low chance that the heart was adversely affected with an abnormal ECG, according to Lipshultz.
Cardiovascular diseases are the leading causes of death among adults. Sudden cardiac deaths also occur in children and teenagers, including otherwise healthy high school athletes. “An ECG screening can identify heart conditions such as supraventricular tachycardia – a rapid acceleration of the heart rhythm – that can cause sudden death,” Lipshultz said. “Fortunately, these life-threatening conditions can usually be treated by cardiologists.”