Electrocardiography does not reliably detect left ventricular hypertrophy in high-risk children

Abstract

Killian L, Simpson JM, Savis A, Rawlins D, Sinha MD. Electrocardiography is a poor screening test to detect left ventricular hypertrophy in children. Arch Dis Child 2010;95:832-6. Among children at high risk for left ventricular hypertrophy (LVH), is electrocardiography (ECG) an adequate screening test compared with echocardiography (ECHO)? Prospective, double-blinded study. A single children's hospital in London, England. 70 consecutive children with chronic kidney disease, age 6.6-17.9 months. Both predialysis and posttransplantation patients were included. Patients underwent both ECG and ECHO on the same day. LVH detected using standard 12-lead ECG was compared in a blinded fashion with that detected with 2D-guided M-mode ECHO. The sensitivity and specificity of ECG were calculated using ECHO as the gold standard. The prevalence of LVH as detected by ECHO ranged from 17% to 55% using different indexation methods. Increased R-wave amplitude using recent age- and sex-specific voltage criteria demonstrated the highest sensitivity (68%-76%) and specificity (43%-77%) for detecting LVH. The negative likelihood ratio for R waves using ECG method B was 0.40. For all other ECG criteria, sensitivity did not exceed 13% irrespective of the ECG or ECHO method used. In children, the standard 12-lead ECG has low sensitivity and a minimally helpful likelihood ratio for detecting LVH. The authors emphasize that these findings are relevant for physiological LVH and should not be extrapolated to the detection of hypertrophic cardiomyopathy. In clinical practice, ECHO alone should be used to exclude LVH.