Plenary Session 14

3月28日［日］08:00-09:30

 
  Revisiting School Cardiac Screening
  
 
   
  学校心臓検診は、その始まりからは60年以上の歴史があるとされるが、学校保健法施行規則の改定により、1995年から現在の小中高校１年生全員に心電図を含む心臓検診が開始された。その後のガイドラインの整備の後に、2016年の学校心臓検診のガイドライン（日本循環器学会、日本小児循環器学会合同）が整備された。現在の学校心臓検診の目的は、小児心疾患の早期発見と管理指導、心臓性突然死の予防が挙げられ、QT延長症候群、心筋疾患、肺動脈性肺高血圧等の個々の疾患について、その有用性が報告されてきた。しかし、本邦において心電図の判読の標準化、均てん化が課題とされる。海外でもその心臓性突然死の予防効果が注目はされているが採用されておらず、心電図判読にかかる人的リソース、費用対効果が課題とされてきた。近年、種々の医学領域で、深層学習の応用がなされ、学校心臓検診の領域でも期待される。また、2019年12月に脳卒中循環器病対策基本法が施行され、今後は、成人病予防の観点からも学校心臓検診の役割が期待される。
以上の点から、ガイドライン整備５年後の時点での本邦の学校心臓検診の達成点を総括し、国内外の課題に対する検診心電図判読への新しい取り組み、成人病予防に対する取り組みについて、欧米の状況も含めて、最近のデータを持ち寄り検討し、今後の課題を探りたい。
School cardiac screening has been conducted for more than 60 years since its beginning in Japan. After the enforcement regulation in the School Health Law was revised, cardiac screening, including electrocardiogram (ECG), was started for all freshmen in elementary, middle and high school in 1995. After the subsequent development of guidelines, the 2016 Guidelines for School Cardiac Screening (Japanese Circulation Society and the Japanese Society of Pediatric Cardiology and Cardiac Surgery) has been released. The objectives of current school cardiac screening are early detection and management of pediatric heart disease and prevention of sudden cardiac death. The usefulness in detecting diseases such as long QT syndrome, myocardial diseases and pulmonary arterial hypertension has been reported. However, standardization and equalization of the interpretation of ECG is a critical issue in Japan. Although its effectiveness in preventing sudden cardiac death has been noted overseas, it has not been adopted as a health care system because human resources and cost-effectiveness have been considered as a challenge.
In recent years, deep learning has been applied in various fields of medical science and is expected to be applied in the field of school cardiac screening. In addition, after the enactment of the Basic Act on Prevention of Cardiovascular Diseases and Stroke in December 2019, school cardiac screening is expected to play an important role in preventing adult-onset cardiovascular diseases.
In light of the above circumstances, we would like to summarize what has been accomplished in school cardiac examinations in Japan as of 5 years after the establishment of the JCS/JSPCCS guideline, and discuss current issues, related to new approaches to ECG interpretation in school children, and efforts to prevent adult-onset cardiovascular diseases to explore the future direction of research, with reference to the status in United States.
 
 
   
 
 
Yoshihide Mitani   Yoshihide Mitani
Department of Pediatrics, Mie University School of Medicine, Tsu
   Jonathan Drezner   Jonathan Drezner
Department of Family Medicine, University of Washington, Seattle, USA
 
 
 
 
   
 
 
Jonathan Drezner   Jonathan Drezner
Department of Family Medicine, University of Washington, Seattle, USA
   Mamoru Ayusawa   Mamoru Ayusawa
Department of Pediatrics, Nihon University School of Medicine, Tokyo
 
 
 
Shuhei Toba   Shuhei Toba
Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu
   Atsushi Sakima   Atsushi Sakima
Health Administration Center, University of the Ryukyus, Okinawa
 
 
 
Tetsuo　Minamino   Tetsuo　Minamino
Department of Cardiorenal and Cerebrovascular Medicine, School of Medicine, Kagawa University, Kagawa