title: 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.
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 Q(III) >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, < or =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%.
  
  
  CONCLUSIONS
  The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex 77030, USA. srivenes@bcm.tmc.edu
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rivenes
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Easley
authors.forename: Samuel
authors.initials: S
authors.lastname: Kaplan
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Khan
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Moodie
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Starc
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Weihong
authors.initials: W
authors.lastname: Zhang
authors.forename: J Timothy
authors.initials: JT
authors.lastname: Bricker
mesh_terms: D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity