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Updated: Apr 26, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Differential diagnosis between left ventricular hypertrophy and cardiomyopathy in childhood
1Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Insights
The electrocardiogram (ECG) shows lower sensitivity for left ventricular pressure overload than cardiomyopathy. However, ECG "strain" patterns and a specific risk score can predict sudden cardiac death risk in hypertrophic cardiomyopathy.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
- Cardiac Electrophysiology
Background:
- Left ventricular hypertrophy (LVH) can result from various etiologies, impacting cardiac function and prognosis.
- Electrocardiogram (ECG) is a primary tool for cardiac assessment, but its diagnostic utility for LVH varies by cause.
- Sudden cardiac death (SCD) remains a significant concern, particularly in pediatric populations with hypertrophic cardiomyopathy (HCM).
Purpose of the Study:
- To describe the sensitivity and specificity of ECG for diagnosing LVH across different etiologies.
- To highlight the prognostic value of ECG findings, specifically ST-T-wave changes ('strain' pattern), for malignant arrhythmias and SCD.
- To evaluate an ECG-based risk score for predicting SCD in pediatric hypertrophic cardiomyopathy.
Main Methods:
- Review and analysis of ECG sensitivity and specificity data for diagnosing LVH due to pressure overload versus cardiomyopathy.
- Examination of the association between ECG 'strain' patterns and the risk of malignant cardiac arrhythmias and SCD.
- Assessment of a validated ECG risk score (voltage and repolarization abnormalities) for SCD prediction in childhood HCM.
Main Results:
- ECG sensitivity for left ventricular pressure overload (<35%) is substantially lower than for cardiomyopathy (55%–87%).
- ST-T-wave changes ('strain' pattern) are common in diverse LVH etiologies and indicate increased risk of SCD.
- In pediatric HCM, an ECG risk score >5 points predicts SCD with 96% sensitivity and 78% specificity (relative risk 24.3).
Conclusions:
- ECG diagnostic performance for LVH is etiology-dependent, being less sensitive for pressure overload than cardiomyopathy.
- Specific ECG patterns ('strain') serve as crucial indicators of heightened risk for life-threatening arrhythmias and SCD.
- The validated ECG risk score is a powerful tool for stratifying SCD risk in pediatric hypertrophic cardiomyopathy.
Abstract:
The sensitivity and specificity of the electrocardiogram for the diagnosis of left ventricular hypertrophy of different etiologies are described. The sensitivity of the electrocardiogram for detecting left ventricular pressure overload is substantially lower (<35%) than the sensitivity for detecting evidence of a cardiomyopathy (55% to around 87%). Attention is drawn to the finding that in many differing etiologies of left ventricular hypertrophy ST-T-wave changes commonly referred to as "strain"-pattern are a harbinger of an increased risk of malignant cardiac arrhythmias and sudden death. In the most common pediatric cause of sudden death, hypertrophic cardiomyopathy, a described ECG risk score, which scores both voltage and repolarization abnormalities, is the most powerful predictor hitherto described for predicting the risk of sudden death in this diagnosis. A point score over 5 points gives a relative risk for sudden death of 24.3 with a sensitivity of 96% and a specificity of 78% in childhood.
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