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

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 Q_III >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.