Prevalence of electrocardiographic abnormalities among Iranian children and adolescents and associations with blood pressure and obesity: findings from the SHED LIGHT study.

BACKGROUND: There are few studies for detecting rhythm abnormalities among healthy children and adolescents. The aim of the study was to investigate the prevalence of abnormal electrocardiographic findings in the young Iranian population and its association with blood pressure and obesity. METHODS: A total of 15084 children and adolescents were examined in a randomly selected population of Tehran city, Iran, between October 2017 and December 2018. Anthropometric values and blood pressure measurements were also assessed. A standard 12-lead electrocardiogram was recorded by a unique recorder, and those were examined by electrophysiologists. RESULTS: All students mean age was 12.3 ± 3.1 years (6-18 years), and 52% were boys. A total of 2900 students (192.2/1000 persons; 95% confidence interval 186-198.6) had electrocardiographic abnormalities. The rate of electrocardiographic abnormalities was higher in boys than girls (p < 0.001). Electrocardiographic abnormalities were significantly higher in thin than obese students (p < 0.001), and there was a trend towards hypertensive individuals to have more electrocardiographic abnormalities compared to normotensive individuals (p = 0.063). Based on the multivariable analysis, individuals with electrocardiographic abnormalities were less likely to be girls (odds ratio 0.745, 95% confidence interval 0.682-0.814) and had a lower body mass index (odds ratio 0.961, 95% confidence interval 0.944-0.979). CONCLUSIONS: In this large-scale study, there was a high prevalence of electrocardiographic abnormalities among young population. In addition, electrocardiographic findings were significantly influenced by increasing age, sex, obesity, and blood pressure levels. This community-based study revealed the implications of electrocardiographic screening to improve the care delivery by early detection.

Cost-effectiveness of cardiovascular magnetic resonance imaging compared to common strategies in the diagnosis of coronary artery disease: a systematic review.

Cardiovascular magnetic resonance imaging (CMR) has established exceptional diagnostic utility and prognostic value in coronary artery disease (CAD). An assessment of the current evidence on the cost-effectiveness of CMR in patients referred for the investigation of CAD is essential for developing an economic model to evaluate the cost-effectiveness of CMR in CAD. We conducted a comprehensive search of multiple electronic databases, including PubMed, Scopus, Web of Science core collection, Embase, National Health Service Economic Evaluation Database (NHS EED), and health technology assessment, to identify relevant literature. After removing duplicates and screening the title/abstract, a total of 13 articles were deemed eligible for full-text assessment. We included studies that reported one or more of the following outcomes: incremental cost-effectiveness ratio (ICER), cost per quality-adjusted life year (QALYs), cost per life year gained, sensitivity and specificity rate as the primary outcome, and health utility measures or health-related quality of life as the secondary outcome. The quality of the included studies was assessed using the CHEERS 2022 guidelines. The findings of this study demonstrate that in patients undergoing urgent percutaneous coronary intervention, CMR over a one-year and lifetime horizon leads to higher quality-adjusted life years (QALYs) compared to current strategies in cases of multivessel disease. The systematic review indicates that the CMR-based strategy is more cost-effective when compared to standard methods such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA), and coronary angiography (CA) (CMR = $19,273, SPECT = $19,578, CCTA = $19,886, and immediate CA = $20,929). The results also suggest that the CMR strategy can serve as a cost-effective gatekeeping tool for patients at risk of obstructive CAD. A CMR-based strategy for managing patients with suspected CAD is more cost-effective compared to both invasive and non-invasive strategies, particularly in real-world patient populations with a low to intermediate prevalence of the disease.

Prevalence of Structural Heart Diseases Detected by Handheld Echocardiographic Device in School-Age Children in Iran: The SHED LIGHT Study.

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population. Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Results: Of 15,130 students (6-18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers' low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening.

Development, Implementation, and Evaluation of an Educational Package to Control the Biomedical Profile of Metabolic Syndrome.

BACKGROUND: Unhealthy lifestyle behaviors are a major concern in the development of metabolic syndrome (MetS). This study aimed to develop, implement, and evaluate a lifestyle education package as a strategy to control the biomedical components of MetS. METHODS: A total of 72 women and men (aged 18-68 y) with MetS were selected through randomized sampling. They were classified into 2 groups: an intervention group that received a lifestyle educational package with close follow-ups and a control group that received only usual care. Anthropometric indices, blood pressure, lipid profiles, and fasting blood sugar were assessed at baseline and after 3 months. RESULTS: The lifestyle-modification program was associated with a modest weight loss (2 ± 0.4 kg; P < 0.001), a significant reduction in waist circumference (2.3 ± 0.9 cm; P < 0.001) and the hip circumference (1 ± 0.3 cm; P < 0.001), and a sharp decrease in diastolic blood pressure (5.3 ± 1.4 mm Hg; P < 0.001), compared with the baseline values in the intervention group. Additionally, according to the one-way MANOVA analysis, 33.8% of the changes in MetS components were attributable to the educational intervention (P < 0.001, F = 5.27). CONCLUSIONS: Improvement in lipid profile and anthropometric measures suggest that a lifestyle package based on multivariable health education is an acceptable method.

Management of Cardiovascular Disorders in Patients with Noonan Syndrome: A Case Report.

The Noonan syndrome is a rare disorder, one of whose major complications is cardiovascular involvement. A wide spectrum of congenital heart diseases has been observed in this syndrome. The most common cardiac disorder is pulmonary valve stenosis, which has a progressive nature. Hypertrophic cardiomyopathy is less common, but its morbidity and mortality rates are high. We herein introduce a 12-year-old boy with the typical findings of the Noonan syndrome. His symptoms began from infancy, and there was a gradual exacerbation in his respiratory and cardiac manifestations with age. The cardiac involvement included right ventricular outflow tract and pulmonary valve stenosis, hypertrophic cardiomyopathy, and subaortic valve stenosis. Due to the progressive course of the disease, surgical repair was done. Although the patient had a difficult postoperative period, his general condition improved and he was discharged. At 3 months' follow-up, his symptoms showed improvement. Additionally, there was a reduction in the echocardiographic parameters of the outflow tract stenosis gradient as well as a significant improvement in the cardiac hemodynamic indices.

Accuracy of Doppler-derived indices in predicting pulmonary vascular resistance in children with pulmonary hypertension secondary to congenital heart disease with left-to-right shunting.

This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children with pulmonary hypertension secondary to congenital heart disease with left-to-right shunting. Doppler-derived indices including the acceleration time corrected (AcTc), deceleration time corrected, deceleration index, peak velocity, heart-rate-corrected inflection time (InTc), and a new index (the acceleration slope [Acc = peak flow velocity/AcTc]) were measured from the pulmonary artery (PA) systolic flow curve before and after 100 % oxygen administration in the main, left, and right PAs of 33 children. The acquired data were compared between low and high pulmonary vascular resistance (PVR) groups and between responders and nonresponders to the vasoreactivity test. The AcTc values differed significantly between the low and high PVR groups before and after oxygen administration in the main (P = 0.032 and <0.001, respectively), right (P = 0.011 and <0.001, respectively), and left (P < 0.001 and <0.001, respectively) PAs. The AcTc cutoff point in the main PA was 3.44 before oxygen administration (81% sensitivity and 91% specificity). The InTc in the main PA and its changes differed significantly between the low and high PVR groups before and after oxygen administration and between the responders and nonresponders (P = 0.016, 0.046, and 0.021, respectively). The velocity changes of the PA in the main PA differed significantly between the responders and nonresponders to oxygen administration (P < 0.001). The Acc and its changes differed significantly between the low and high PVR groups after oxygen administration and between the responders and nonresponders to oxygen administration (P = 0.044 and 0.006, respectively). Doppler echocardiographic examination using PA systolic flow indices in addition to PA reactivity testing is a promising technique for assessing PVR in children with congenital heart disease.