title: Electrocardiography Screening for Hypertrophic Cardiomyopathy.
abstract: BACKGROUND
  Hypertrophic cardiomyopathy (HCM) is the leading cause of sudden cardiac death in athletes. However, preparticipation electrocardiogram (ECG) screening has been criticized for failing to meet cost-effectiveness thresholds, in part because of high false-positive rates. We sought to evaluate whether a highly automated software algorithm could be used for a high throughput, population-based screening program and address several of the limitations seen with population-based screening
  
  
  METHODS
  A proprietary computed algorithm was created based on both voltage- as well as Seattle-based ECG criteria. Different cut points for Q-wave depth, Q-wave length, the degree of ST depression, the degree of T-wave inversion, and left ventricular voltage were analyzed for optimum sensitivity and specificity. After developing receiver operating characteristic curves for each criterion, different cut points were trialed together on our data set to obtain settings to optimize sensitivity and specificity.
  
  
  RESULTS
  The automated algorithm was capable of identifying patients with HCM based on ECG with 88.6% sensitivity and 98% specificity, compared to a sensitivity of 90.2% and specificity of 96% when the ECGs were read by physicians according to the Seattle Criteria. Adding voltage criteria improved the sensitivity of the algorithm with a mild decrease in specificity. Optimum sensitivity with this automated software was 98%; optimum specificity was 96%.
  
  
  CONCLUSIONS
  Computer-automated ECG screening for HCM is feasible. Evaluation of automated ECG algorithms in larger and more diverse populations is warranted.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Campbell
authors.affiliation: Department of Electrical Engineering and Computing Systems, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Xuefu
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Electrical Engineering and Computing Systems, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Chia
authors.initials: C
authors.lastname: Han
authors.affiliation: Department of Electrical Engineering and Computing Systems, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Hedayat
authors.initials: H
authors.lastname: Abrishami
authors.affiliation: Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Gregory
authors.initials: G
authors.lastname: Webster
authors.affiliation: Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Knilans
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Richard.czosek@cchmc.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Czosek
mesh_terms: D000293:Adolescent; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: ECG screening; Seattle Criteria; hypertrophic cardiomyopathy