title: ECG is an inefficient screening-tool for left ventricular hypertrophy in normotensive African children population.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) is a marker of pediatric hypertension and predicts development of cardiovascular events. Electrocardiography (ECG) screening is used in pediatrics to detect LVH thanks to major accessibility, reproducibility and easy to use compared to transthoracic echocardiography (TTE), that remains the standard technique. Several diseases were previously investigated, but no data exists regarding our study population. The aim of our study was to evaluate the relationship between electrocardiographic and echocardiographic criteria of LVH in normotensive African children.
  
  
  METHODS
  We studied 313 children (mean age 7,8 ± 3 yo), in north-Madagascar. They underwent ECG and TTE. Sokolow-Lyon index was calculated to identify ECG-LVH (>35 mm). Left ventricle mass (LVM) with TTE was calculated and indexed by height(2.7) (LVMI(2.7)) and weight (LVMI(w)). We report the prevalence of TTE-LVH using three methods: (1) calculating percentiles age- and sex- specific with values >95th percentile identifying LVH; (2) LVMI(2.7) >51 g/m(2.7); (3) LVMI(w) >3.4 g/weight.
  
  
  RESULTS
  40 (13%) children showed LVMI values >95th percentile, 24 children (8%) an LVMI(2.7) >51 g/m(2.7) while 19 children (6%) an LVMI(w) >3.4 g/kg. LVH-ECG by Sokolow-Lyon index was present in five, three and three children respectively, with poor values of sensitivity (ranging from 13 to 16%), positive predictive value (from 11 to 18%) and high values of specificity (up to 92%). The effects of anthropometrics parameters on Sokolow-Lyon were analyzed and showed poor correlation.
  
  
  CONCLUSIONS
  ECG is a poor screening test for detecting LVH in children. In clinical practice, TTE remains the only tool to be used to exclude LVH.
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Creta
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Cosimo Marco
authors.initials: CM
authors.lastname: Campanale
authors.affiliation: Paediatric Cardiothoracic Surgery, Starship Greenlane Paediatric and Congenital Heart Service , Auckland , New Zealand.
authors.forename: Mario
authors.initials: M
authors.lastname: Fittipaldi
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giorgino
authors.affiliation: Department of Medicine and Surgery, Service of Pediatrics, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Quintarelli
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Satriano
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cruciani
authors.affiliation: Heart and Great Vessels "Attilio Reale", University of Roma "La Sapienza" , Rome , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Antinolfi
authors.affiliation: Department of Medicine and Surgery, Geriatric Surgery Unit, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Berardino
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Costanzo
authors.affiliation: Cardiology Department, University of Pisa , Pisa , Italy.
authors.forename: Ranieri
authors.initials: R
authors.lastname: Bettini
authors.affiliation: Department of Medicine and Surgery, Geriatric Surgery Unit, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mangiameli
authors.affiliation: Department of Medicine and Surgery, Geriatric Surgery Unit, Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Caricato
authors.affiliation: Institute of Philosophy of Scientific and Technological Practise (FAST), Campus Bio-Medico University of Rome , Rome , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mottini
keywords: African children; ECG; Screening; Ventricular hypertrophy