title: Novel electrocardiographic screening criterion for hypertrophic cardiomyopathy in children.
abstract: Electrocardiography is often advocated as a screening tool in children for hypertrophic cardiomyopathy (HC). We sought to establish an electrocardiographic screening tool to identify children with HC. We hypothesized that a pediatric-specific electrocardiographic criterion would perform better than the popular criteria used for screening children for left ventricular hypertrophy and HC. The earliest available electrocardiogram for children (n=108) with HC (ages 7 to 21 yrs) was reviewed. We sought to compare the diagnostic accuracy of 4 screening algorithms: (1) Sokolow-Lyon criterion (SV1+RV5/RV6>35 mm), (2) Cornell criterion (RaVL+SV3>28 mm in men, 20 mm in women), (3) total 12-lead voltage criterion (R wave to the nadir of Q/S wave>175 mm), and (4) pediatric-specific criterion (RaVL+SV2>23 mm). The same criteria were applied to a cohort of age-matched and gender-matched controls without cardiac disease. Statistically significant correlations were found between children with HC and positive screen using all 4 criteria. However, comparison of receiver operating characteristic demonstrated an area under the curve of 0.67 for Sokolow-Lyon criterion, 0.70 for Cornell criterion, 0.83 for total 12-lead criterion, and 0.82 for pediatric-specific criterion. Pediatric-specific criterion had superior sensitivity in gene-positive children and superior overall specificity than total 12-lead criterion. In conclusion, our study demonstrates that the pediatric-specific criterion employing leads RaVL+SV2 is more accurate in identifying children with HC in comparison with other popular screening criteria.
authors: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Matthew B
authors: MB
authors: Brothers
authors: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Matthew E
authors: ME
authors: Oster
authors: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Alexandra
authors: A
authors: Ehrlich
authors: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
authors: Margaret J
authors: MJ
authors: Strieper
authors: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. Electronic address: mahlew@kidsheart.com.
authors: William T
authors: WT
authors: Mahle
mesh_terms: D000293:Adolescent; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D003430:Cross-Sectional Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult