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ECG criteria for diagnosing left chambers disease in Pediatrics: The CHILDHEART study
José Nunes de Alencar1, Jade Arruda Motta Monteiro2, Julia Teuber Furtado2
1Electrocardiology. Instituto Dante Pazzanese de Cardiologia. São Paulo. Brazil; Research Division. Instituto Dante Pazzanese de Cardiologia. São Paulo. Brazil.
Insights
Standard electrocardiogram (ECG) criteria show limited accuracy for diagnosing left atrial (LA) and left ventricular (LV) disease in children. Novel ECG indices, like RI + RV6, show promise for improved pediatric cardiac diagnostics.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Electrocardiography
Background:
- Left atrial (LA) and left ventricular (LV) diseases are significant concerns in pediatric cardiology.
- Accurate diagnosis in children is crucial for timely intervention and management.
- Traditional electrocardiogram (ECG) criteria may have limitations in pediatric populations due to age-related physiological differences.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ECG criteria for detecting LA and LV disease in pediatric patients.
- To compare the performance of traditional and novel ECG criteria across different age groups (under 3 years and 3 years or older).
- To identify ECG indices that can reliably diagnose cardiac abnormalities in children.
Main Methods:
- Retrospective case-control study (CHILDHEART Project) including pediatric patients (0-14 years) with diagnosed LA or LV disease and control groups.
- Evaluation of traditional and novel ECG criteria for diagnostic performance.
- Stratification of participants into two age groups: under 3 years and 3 years or older.
- Calculation of sensitivity, specificity, likelihood ratios, and ROC curves.
Main Results:
- Traditional ECG criteria (e.g., Morris sign) showed low sensitivity and specificity for LA hypertrophy in both age groups.
- The Modified Peguero-Lo Presti index demonstrated varying diagnostic utility based on age-specific cutoffs.
- The novel RI + RV6 index showed consistent performance across age groups, with higher positive likelihood ratios (LR+) compared to traditional criteria.
Conclusions:
- Standard ECG criteria are often inadequate for diagnosing LA and LV disease in pediatric patients.
- The RI + RV6 index, with a single cutoff, and age-stratified thresholds for the Modified Peguero-Lo Presti index may enhance diagnostic accuracy.
- Further validation of novel ECG indices is warranted for improved pediatric cardiac diagnosis.
Objectives:
To evaluate the diagnostic accuracy of electrocardiographic (ECG) criteria for detecting left atrial (LA) and left ventricular (LV) disease in pediatric patients using age-specific analysis.
Study Design:
This retrospective case-control study, part of the CHILDHEART Project, included pediatric patients aged 0 to 14 years diagnosed with LA disease (n = 152) or LV disease (n = 213), along with control groups (LA controls n = 1485; LV controls n = 1424). ECGs were evaluated for traditional and novel criteria. Participants were stratified into two age groups: under 3 years and 3 years or older. Sensitivity, specificity, likelihood ratios, and receiver operating characteristic (ROC) curves were calculated to assess diagnostic performance.
Results:
Traditional ECG criteria for LA hypertrophy, such as the Morris sign, demonstrated limited diagnostic accuracy, showing low sensitivity and specificity across both age groups. A P wave amplitude in lead II ≥2.5 mm cannot accurately distinguish right atrial diseases from LA hypertrophy. For LV hypertrophy, the Modified Peguero-Lo Presti index (SV3 + SV4) yielded an LR+ of 11.88 in children <3 years (cutoff ≥35 mm) and 11.36 in those ≥3 years (cutoff ≥49 mm). A new index (RI + RV6) performed consistently across both age groups, with an LR+ of 21.32 for <3 years and 7.87 for ≥3 years using a fixed cutoff of ≥37 mm. Both indices had limited utility in ruling out disease due to low LR- values.
Conclusions:
Standard ECG criteria may not be adequate for diagnosing LA and LV disease in pediatric patients. The RI + RV6 index, using a single cutoff across ages, and age-stratified thresholds for the Modified Peguero-Lo Presti index may improve diagnostic accuracy.
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