Electrocardiographic measures of left ventricular hypertrophy in children across the distribution of blood pressure: the Muscatine study.

Abstract

We sought to test the effectiveness of the ECG as a measure of increased left ventricular wall mass in children with high blood pressure. One hundred eighty-one children, ages 9-18 years, were selected from the lowest, middle and highest quintile of systolic blood pressure from the Muscatine Study, based upon two biennial school screenings. After correction for age, sex, height, weight and skinfold thickness, children with the highest blood pressure had increased echocardiographic left ventricular wall mass (p less than 0.02). Voltage measurements of maximum R and S waves in the standard and precordial leads were measured by computer. We correlated blood pressure and echocardiographic measurements of the interventricular septum, left ventricular posterior wall and left ventricular wall mass to electrocardiographic combinations used to predict left ventricular hypertrophy in both children and adults. The electrocardiographic correlations ranged from -0.01 to + 0.17. Poor correlations were found between electrocardiographic measures and blood pressure, left ventricular wall thickness or left ventricular wall mass. Skinfold thickness and weight had negative correlations, suggesting a damping effect upon measured voltage. We conclude that the echocardiogram is a more sensitive measurement of increased left ventricular mass than the ECG in children with elevated blood pressure.