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

Shannon M. Rivenes, Steven D. Colan, Kirk A. Easley, Samuel Kaplan, Kathy J. Jenkins, Mohammed N. Khan, Wyman W. Lai, Steven E Lipshultz, Douglas S. Moodie, Thomas J. Starc, George Sopko, Weihong Zhang, J. Timothy Bricker

Research output: Contribution to journalArticle

24 Citations (Scopus)

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 QIII >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, ≤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%. Conclusion: The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.

Original languageEnglish
Pages (from-to)716-723
Number of pages8
JournalAmerican Heart Journal
Volume145
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

Fingerprint

Left Ventricular Hypertrophy
Multicenter Studies
HIV Infections
Electrocardiography
HIV
Pediatrics
Lung
Weights and Measures
Body Surface Area

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Rivenes, Shannon M.; Colan, Steven D.; Easley, Kirk A.; Kaplan, Samuel; Jenkins, Kathy J.; Khan, Mohammed N.; Lai, Wyman W.; Lipshultz, Steven E; Moodie, Douglas S.; Starc, Thomas J.; Sopko, George; Zhang, Weihong; Bricker, J. Timothy.

In: American Heart Journal, Vol. 145, No. 4, 01.04.2003, p. 716-723.

Research output: Contribution to journalArticle

Rivenes, Shannon M. ; Colan, Steven D. ; Easley, Kirk A. ; Kaplan, Samuel ; Jenkins, Kathy J. ; Khan, Mohammed N. ; Lai, Wyman W. ; Lipshultz, Steven E ; Moodie, Douglas S. ; Starc, Thomas J. ; Sopko, George ; Zhang, Weihong ; Bricker, J. Timothy. / 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. In: American Heart Journal. 2003 ; Vol. 145, No. 4. pp. 716-723.
@article{9b91d18091cd45b99c0c4559d5f739b7,
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 QIII >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, ≤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{\%}. Conclusion: The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.",
author = "Rivenes, {Shannon M.} and Colan, {Steven D.} and Easley, {Kirk A.} and Samuel Kaplan and Jenkins, {Kathy J.} and Khan, {Mohammed N.} and Lai, {Wyman W.} and Lipshultz, {Steven E} and Moodie, {Douglas S.} and Starc, {Thomas J.} and George Sopko and Weihong Zhang and Bricker, {J. Timothy}",
year = "2003",
month = "4",
day = "1",
doi = "10.1067/mhj.2003.15",
language = "English",
volume = "145",
pages = "716--723",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Usefulness of the pediatric electrocardiogram in detecting left ventricular hypertrophy

T2 - Results from the prospective pediatric pulmonary and cardiovascular complications of vertically transmitted HIV infection (P2C2 HIV) multicenter study

AU - Rivenes, Shannon M.

AU - Colan, Steven D.

AU - Easley, Kirk A.

AU - Kaplan, Samuel

AU - Jenkins, Kathy J.

AU - Khan, Mohammed N.

AU - Lai, Wyman W.

AU - Lipshultz, Steven E

AU - Moodie, Douglas S.

AU - Starc, Thomas J.

AU - Sopko, George

AU - Zhang, Weihong

AU - Bricker, J. Timothy

PY - 2003/4/1

Y1 - 2003/4/1

N2 - 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 QIII >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, ≤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%. Conclusion: The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.

AB - 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 QIII >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, ≤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%. Conclusion: The ECG is a poor screening tool for identifying LVH in children. Sensitivity is not improved with revision of current criteria.

UR - http://www.scopus.com/inward/record.url?scp=0345701474&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0345701474&partnerID=8YFLogxK

U2 - 10.1067/mhj.2003.15

DO - 10.1067/mhj.2003.15

M3 - Article

C2 - 12679770

AN - SCOPUS:0345701474

VL - 145

SP - 716

EP - 723

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 4

ER -