Electrocardiography is a poor screening test to detect left ventricular hypertrophy in children

Abstract

In children, the standard 12-lead electrocardiogram has low sensitivity and low NPV for detecting LVH. These findings are relevant for physiological LVH and should not be extrapolated to detection of hypertrophic cardiomyopathy. In clinical practice, ECHO alone should be used to exclude LVH.

Peripheral microvascular function is altered in young individuals at risk for hypertrophic cardiomyopathy and correlates with myocardial diastolic function

“…It is also unable to distinguish HCM from the physiological hypertrophy often observed in young endurance athletes (4,18,25,44). The ECG-related findings in the present study further corroborate these previous results.…”

“…Standard 12-lead ECG, although useful for detecting indirect signs of LVH and overload in patients with overt HCM, has poor specificity in the early phase of the disease and low predictability of major cardiac events (18,25). It is also unable to distinguish HCM from the physiological hypertrophy often observed in young endurance athletes (4,18,25,44).…”

“…The risk for HCM-related cardiac events, including sudden cardiac death, appears to be highest in childhood, with a peak incidence of up to 10% during the first decades of life (3,26,29,42). ECGs are often normal through the early phases of hypertrophy (18,25). The diagnosis of HCM, currently based on echocardiographic demonstration of regional or diffuse thickening of the myocardium, is more difficult in younger patients due to the progressive nature of the disease (33, 36).…”

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…A 12-lead ECG adds little to early 21 detection of cardiac end-organ damage (LVH) due to its overall poor reliability in children (111,112).…”

Accuracy of the Electrocardiograph in Detecting Cardiac Left Ventricular Hypertrophy in Pediatric Patients with Aortic Valve Disease

“…A variety of indices may be applied to ECG lead voltages, including the Sokolow-Lyon/JACC (SV1+RV5 or SV1+RV6) or Cornell (SV3+RaVL) threshold voltage criteria for LVH (Table 2). However, these criteria typically lack sensitivity, and accordingly the utility of ECGs in LVH screening has been called into question [13]. Reported ECG sensitivities range from under 20% in HIV-positive children [14] to 67% in patients with aortic stenosis or septal defects [11].…”