[原著]高校生の心臓病検診と心電図自動解析の応用 : 1979年度沖縄県県立高校心臓病検診
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Purpose; The aim of this report was to evaluate the screening examihations for cardiac diseases which were given to high school students on Okinawa in 1979 and to explain future prospects, importances, management and improvements as regards this kind of examinations. Method; The first step screening check up was performed by reviewing the history sheets which included the individual present, past and family histories, findings of the physical exammation, and the X-ray photographs of the chest for 17,655 high school freshmen on Okinawa in 1979. Through this step 610 students were selected by marking one or more definite or suspicious positive check points. Second step screening was carried out by 12 leads ECGs which were analysed by computer. Additionally, they were separately overread by two cardiologists in reference to the history sheets, physical examination data and X-ray photographs. 38 students out of 610, were absent on the second step examination. After all ECGs were recorded in 572 cases and computer analysis were done in 503 cases exept 69 cases which were analysed only by manual process, mainly because difficult transportation of big terminal apparatus to distant place or isolated islands. Analysis numbers and case numbers were not conmcident because double diagnosis might be given in one case. Results; It is convienient to de∝ribe the results separately for the pattern and rhythm diagnosis of the ECGs. For the former, there are 3 cases, 0.52% of QS pattern EGG tracing; 67 cases, 11.7% of high R voltage of left chest leads; 16 cases, 2.80% of R/S>1 of V_1 lead; 44 cases, 7.69 % of right bundle branch block including incomplete cases; 1 case, 0.17% of left atnal strain pattern satisfied by Morris index; 2 cases, 0.35% of right atrial strain pattern; 2 cases, 0.35% of first degree AV block; and 3 eases, 0.52% of QT prolongation. For the latter, there are 5 cases, 0.87% of ventricutetr and supreventricular ectopic beats; 5 cases, 0.87 % of idionodal rhythm; 1 case of Wenchebach AV block; 1 case of wandering pace maker; 1 case of isofrequent AV interference dissociation ; and no cases of atrial fibrillation. Because of the different criteria for diagnosis used in this study, considerably different data were obtained in this senes when compared with the Dokkyo High School report and the Tsuda's report.Concerning the results of the computer analysis, correct pattern diagnosis were obtained in 52.96% of STT changes, 57.7% of high voltage of left precordial leads, 26.3% of right bundle branch block, 8.3% of WPW syndrome, and 76.8% of normal tracing. No correct pattern diagnosis were found out of QS pattern ECG, right ventricular hypertroqhy, left and right atnal strain, and QT prolongation. In pattern analysis 342 cases out of 519 total cases of computer analysis, 65.9%, showed correct diagnosis. There were 73 cases of false negatives, 94 cases of false positives, and 104 cases of misdiagnosis. Misdiagnosis meant that wrong diagnosis except normal tracings was typed out. In rhythm analysis, correct diagnosis were obtaind in 1OO% of the cases of idionodal rhythm, but in none out of 6 cases of premature beats. In rhythm analysis 347 cases out of 534 total cases, 65.0%, revealed correct diagnosis. There were 147 cases of false negatives, 39 of false positives, and 41 cases of misdiagnosis. There were 44 cases of irregular rhythm which meant undecidable arrhythmia. Discussion; Cardiac examination of high school students have been held for the following significant objects: 1) early detection of operable congenital heart disease. 2) prevention of sudden death. 3) suppression of the incidence of rheumatic heart disease. 4) early control of risk factors regarding coronary heart disease. Exact final diagnosis were not obtaind in every cases because further investigations could not be compulsanly carred out. Some of these results suggested possibilities of mitral prolapses, Jervell-Lange-Nielsen syndrome including the Romano-Ward syndrome, hypertrophic obstractive cardiomyopathy, hypertrtrophic cardiomyopathy and mucocutaneous lymphnode syndrome which have a possibility of sudden death. Careful investigations should be done by experienced cardiologists in the second and third steps of cardiac examinations of high shool students, Computer analysis are not yet dependable, and overreading is still necessary at the present time. However, more useful and exact answers can be given by creating comprehensive computer analysis program of 12 leads ECG, PCG, individual histories, findings UCG and so on. Conclusions; As the second step cardiac examination computer analysis of 12 leads ECG were performed in 610 cases who were chosen by first step routine check up out of 19,995 high school freshmen on Okinawa. 151 cases, 26.4% in pattern analysis and 26 cases, 4.5% in rhyhtm analysis revealed adnormalities by computer analysis overread by cardiologists. Correct diagnosis were obtained in 66% in pattern analysis and in 65% in rhyhtm analysis only by computer procedure. For this reason overreacting is still necessary, for giving final ECG judgment. Computer analysis is useful for rapidity and standadizationof measurement and diagnosis, especially, in mass screenings.
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