ECG criteria and diagnostic score for right ventricular disease in children: The CHILDHEART study

To evaluate age-specific electrocardiographic (ECG) criteria to improve the diagnosis of right ventricular disease (RVD) in pediatric patients.

This retrospective case-control study included 246 pediatric patients aged 0 to 14 years with confirmed RVD and 1391 age-matched controls without RVD. ECGs were analyzed to identify relevant criteria, including RV1 amplitude, SV6 amplitude, combined RV1 + SV6 amplitude, right bundle branch block (RBBB), and others. Multivariate logistic regression was used to develop the CHILDHEART diagnostic score, which was internally validated using bootstrap methods.

The CHILDHEART score demonstrated strong diagnostic accuracy for RVD across all age groups. In children under 3 years, the score achieved an area under the curve (AUC) of 0.84, with a positive likelihood ratio (LR+) of 15.97 for scores of 2 or more, indicating high specificity. In children aged 3 years or older, the AUC was 0.81, and the LR+ was 35.77 for scores of 2 or more, emphasizing its clinical utility. Significant predictors included RBBB and RV1 + SV6 ≥ 18 mm.

The CHILDHEART score is a reliable tool for diagnosing RVD in pediatric patients, offering robust diagnostic accuracy across different age groups. Its implementation could enhance clinical decision-making and improve patient outcomes. Limitations include the retrospective design and potential selection bias, underscoring the need for prospective studies to further validate these findings.