Usefulness of the pediatric electrocardiogram in detecting left ventricular hypertrophy: Results from the Prospective Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2 HIV) multicenter study

• Type of Material: Article
• Authors: Kirk Easley, Emory University; Shannon M. Rivenes, Baylor College of Medicine; Steven D. Colan, Harvard University; Samuel Kaplan, University of California Los Angeles; Kathy J. Jenkins, Harvard University; Mohammed N. Khan, Harvard University; Wyman W. Lai, Mt Sinai School of Medicine; Steven E. Lipshultz, Harvard University; Douglas S. Moodie, The Cleveland Clinic; Thomas J. Starc, Columbia University; George Sopko, National Heart, Lung and Blood Institute; Weihong Zhang, The Cleveland Clinic; J. Timothy Bricker, Baylor College
• Language: English
• Date: 2003-04-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2003 Mosby, Inc. Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1067/mhj.2003.15
• Title of Journal or Parent Work: American Heart Journal
• ISSN: 0002-8703
• Volume: 145
• Issue: 4
• Start Page: 716
• End Page: 723
• Grant/Funding Information: Supported by the National Heart, Lung, and Blood Institute (N01-HR-96037, NO1-HR-96038, NO1-HR-96039, NO1-HR-96040, NO1-HR-96041, NO1-HR-96042, NO1-HR-96043) and in part by the National Institutes of Health General Clinical Research Center Grants (RR-00188, RR-00533, RR-00071, RR-00645, RR-00865 and RR-00043).
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

Background A shortcoming of the pediatric electrocardiogram (ECG) appears to be its inability to accurately detect left ventricular hypertrophy (LVH). This study prospectively assesses the usefulness of the pediatric ECG as a screening modality for LVH. Methods Concomitant echocardiograms and ECGs from a large cohort of children who were exposed to the human immunodeficiency virus (HIV; uninfected) and children who were infected with HIV were compared. By use of the values of Davignon et al, qualitative determination of LVH and quantitative criteria for LVH (RV6, SV1, RV6+SV1, QV6, and QIII >98% for age, R/SV1 <98% for age, and [−]TV6) were compared to body surface area adjusted for left ventricular (LV) mass z score. Results were then stratified according to weight and weight-for-height z scores. New age-adjusted predicted values were then constructed from children of a mixed race who were HIV-uninfected, ≤6 years old, and similarly assessed. Results The sensitivity rate was <20% for detecting increased LV mass, irrespective of HIV status; the specificity rate was 88% to 92%. The sensitivity rate of the individual criteria ranged from 0 to 35%; the specificity rate was 76% to 99%. Test sensitivities remained low when stratified by weight and weight-for-height z scores. Areas under the receiver operator characteristic curves were between 0.59 and 0.70, also suggesting poor accuracy of the ECG criteria. By use of new age-adjusted predicted values, the sensitivity rate decreased to <17%, and the specificity rate increased to 94% to 100%. Conclusion The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.