title: Pilot study analyzing automated ECG screening of hypertrophic cardiomyopathy.
abstract: Hypertrophic cardiomyopathy (HCM) is one of the leading causes of sudden cardiac death in athletes. However, preparticipation ECG screening has often been criticized for failing to meet cost-effectiveness thresholds, in part because of high false-positive rates and the cost of ECG screening itself.
  
  
  
  The purpose of this study was to assess the testing characteristics of an automated ECG algorithm designed to screen for HCM in a multi-institutional pediatric cohort.
  
  
  
  ECGs from patients with HCM aged 12 to 20 years from 3 pediatric institutions were screened for ECG criteria for HCM using a previously described automated computer algorithm developed specifically for HCM ECG screening. The results were compared to a known healthy pediatric cohort. The studies then were read by trained electrophysiologists using standard ECG criteria and compared to the results of automated screening.
  
  
  
  One hundred twenty-eight ECGs from unique patients with phenotypic HCM were obtained and compared with 256 studies from healthy control patients matched in 2:1 fashion. When presented with the ECGs, the non-voltage-based algorithm resulted in 81.2% sensitivity and 90.7% specificity. A trained electrophysiologist read the same data according to the Seattle Criteria, with 71% sensitivity with 95.7% specificity. The sensitivity of screening as well as the components of the ECG screening itself varied by institution.
  
  
  
  This pilot study demonstrates a potential for automated ECG screening algorithms to detect HCM with testing characteristics similar to that of a trained electrophysiologist. In addition, there appear to be differences in ECG characteristics between patient populations, which may account for the difficulties in universal screening.
authors.affiliation: Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Campbell
authors.affiliation: College of Engineering and Applied Science, Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Xuefu
authors.initials: X
authors.lastname: Zhou
authors.affiliation: College of Engineering and Applied Science, Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Chia
authors.initials: C
authors.lastname: Han
authors.affiliation: College of Engineering and Applied Science, Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Hedayat
authors.initials: H
authors.lastname: Abrishami
authors.affiliation: Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Gregory
authors.initials: G
authors.lastname: Webster
authors.affiliation: Department of Pediatrics, Division of Cardiology, Texas Children's Hospital, Houston, Texas.
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sower
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Knilans
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Richard.czosek@cchmc.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Czosek
mesh_terms: D000293:Adolescent; D000465:Algorithms; D056352:Athletes; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010865:Pilot Projects; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Adolescent; Athlete; Electrocardiography; Hypertrophic cardiomyopathy; Screening; Sudden cardiac death