Skip to main content

Advertisement

SpringerLink
Log in

Validity of electrocardiographic criteria for left ventricular hypertrophy in children with pressure- or volume-loaded ventricles: Comparison with echocardiographic left ventricular muscle mass

  • Original Articles
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

To determine the correlation between electrocardiographic (ECG) findings and anatomy utilizing echocardiography in children with pressure- or volume-loaded left ventricles, we analyzed the preoperative ECG tracings of 19 patients who underwent surgery for significant aortic stenosis and 12 patients who underwent cardiac catheterization or surgery for clinically significant ventricular septal defects. We then compared them with a group of 21 normal controls. The left ventricular muscle mass in these patients was calculated from echocardiograms using the simplified cubed formula. Posterior and septal wall thickness and cavity size were significantly greater in the aortic stenosis group than in the normal group. Only cavity size was significantly greater in the ventricular septal defect group than in the normal group. Eighteen aortic stenosis patients (95%) and ten ventricular septal defect patients (83%) had a left ventricular muscle mass greater than 2 standard deviations above the mean for the normal group. Significant differences were found in the voltages of SV1+RV6 and in the voltage of RV6 alone between normals, aortic stenosis patients, and ventricular septal defect patientsregardless of age. Using conventional ECG criteria for left ventricular hypertrophy, the highest sensitivity in aortic stenosis patients (67%) and ventricular septal defect patients (60%) was modest. The likelihood ratio for a positive test in either group was the best for SV1+RV6 >98th centile for age; RV6>98th centile for age was the best single measurement. No correlation was found between voltage and any measurable hemodynamic or anatomic data. Conventional pediatric ECG criteria for left ventricular hypertrophy have only modest sensitivity regardless of whether the heart is under pressure or volume load. Because left ventricular muscle mass can be precisely determined by echocardiography, these ECG criteria should be applied cautiously.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Badeer AJ (1964) Biological significance of cardiac hypertrophy.Am J Cardiol 14:133–138

    Google Scholar 

  2. Beck JR (1986) Likelihood ratios: another enhancement of sensitivity and specificity.Arch Pathol Lab Med 110:685–686

    Google Scholar 

  3. Brohet CR, Robert A, Derwael C, et al. (1984) Computer interpretation of pediatric orthogonal electrocardiograms: statistical and deterministic classification methods.Circulation 70:255–262

    Google Scholar 

  4. Cabrera E, Monroy J (1952) Systolic and diastolic loading of the heart. II. Electrocardiographic data.Am Heart J 43:669–686

    Google Scholar 

  5. Casale PN, Devereux RB, Alonso DR, Campo E, Klingfield P (1987) Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings.Circulation 75:565–572

    Google Scholar 

  6. Casale PN, Devereux RB, Klingfield P, et al. (1985) Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria.J Am Coll Cardiol 6:572–580

    Google Scholar 

  7. Cooksey JD, Dunn M, Massie E (1977)Clinical Vectorcardiography and Electrocardiography, 2nd edn. Year Book, Chicago, pp 9–112

    Google Scholar 

  8. Daniels SR, Meyer RA, Liang Y, Bove KE (1988) Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults.J Am Coll Cardiol 12:703–708

    Google Scholar 

  9. Davignon A, Rautaharju P, Boisselle E, et al. (1979) Normal ECG standards for infants and children.Pediatr Cardiol 1: 123–131

    Google Scholar 

  10. De Simone G, Daniels SR, Devereux RB, et al. (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight.J Am Coll Cardiol 20:1251–1260

    Google Scholar 

  11. Devereux RB (1990) Is the electrocardiogram still useful for detection of left ventricular hypertrophy?Circulation 81: 1144–1146

    Google Scholar 

  12. Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man: anatomic validation of the method.Circulation 55:613–618

    Google Scholar 

  13. Devereux RB, Alonso DR, Lutas EM, et al. (1986) Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings.Am J Cardiol 57:450–458

    Google Scholar 

  14. Einthoven W, Fahr G, de Waart A (1913) On the direction and manifest size of the variations of potential in the human heart and on the influence of the position of the heart on the form of the electrocardiogram [translated by Hoff HE, Sekelj P from the original inPfleugers Arch Ges Physiol 150:275, 1950].Am Heart J 40:163–211

    Google Scholar 

  15. Garson A (1983)The Electrocardiogram in Infants and Children: A Systematic Approach, 1st edn. Lea & Febiger, Philadelphia, pp 61–81, 396–404

    Google Scholar 

  16. Graham TP (1991) Ventricular performance in congenital heart disease.Circulation 84:2259–2274

    Google Scholar 

  17. Graham TP, Jarmakani JM, Canent RV, Capp MP, Spach MS (1968) Characterization of left heart volumes and mass in normal children and infants with intrinsic myocardial disease.Circulation 38:826–837

    Google Scholar 

  18. Graham TP, Jarmakani JM, Canent RV, Morrow MN (1971) Left heart volume estimation in infancy and childhood.Circulation 43:895–904

    Google Scholar 

  19. Graham TP, Lewis BW, Jarmakani MM, Canent RV, Capp MP (1970) Left heart volumes and mass quantification in children with left ventricular pressure overload.Circulation 41:203–212

    Google Scholar 

  20. Griner PF, Mayewski RJ, Mushlin AI, Greenland P (1981) Selection and interpretation of diagnostic tests and procedures: principles and applications.Ann Intern Med 94:557–600

    Google Scholar 

  21. Hashida E, Nishi T (1988) Constitutional and echocardiographic variability of the normal electrocardiogram in children.J Electrocardiol 21:231–237

    Google Scholar 

  22. Henry WL, Ware J, Gardin JM, et al. (1978) Echocardiographic measurements in normal subjects: growth related changes that occur between infancy and early adulthood.Circulation 57:278–285

    Google Scholar 

  23. Horan LG (1987) Manifest orientation: the theoretical link between the anatomy of the heart and the clinical electrocardiogram.J Am Coll Cardiol 9:1049–1056

    Google Scholar 

  24. Hossack KF, Neutze JM, Lowe JB, Barratt-Boyles BG (1980) Congenital valvar aortic stenosis: natural history and assessment for operation.Br Heart J 43:561–573

    Google Scholar 

  25. Ito S, Okuni M, Hosaki J, et al. (1986) Effects of fatness on the electrocardiogram in children aged 12–15 years.Pediatr Cardiol 6:249–251

    Google Scholar 

  26. Jarmakani JMM, Graham TP, Canent RV, Jewett PH (1972) Left heart function in children with tetralogy of Fallot before and after palliative or corrective surgery.Circulation 46:478–490

    Google Scholar 

  27. Jarmakani JMM, Graham TP, Canent RV, Spach MS, Capp MP (1969) Effect of site of shunt on left heart volume characteristics in children with ventricular septal defect and patent ductus arteriosus.Circulation 40:411–418

    Google Scholar 

  28. Laird WP, Fixler DE (1981) Left ventricular hypertrophy in adolescents with elevated blood pressure: assessment by chest roentgenography, electrocardiography and echocardiography.Pediatrics 67:255–259

    Google Scholar 

  29. Levy D, Labid SB, Anderson KM, et al. (1990) Determinants of sensitivity and specificity of the electrocardiographic criteria for left ventricular hypertrophy.Circulation 81:815–820

    Google Scholar 

  30. Linzbach AJ (1976) Hypertrophy, hyperplasia and structural dilatation of the humar heart.Adv Cardiol 18:1–13

    Google Scholar 

  31. Louie EK, Maron BJ (1986) Hypertrophic cardiomyopathy with extreme increase in left ventricular wall thickness: functional and morphologic features and clinical significance.J Am Coll Cardiol 8:57–65

    Google Scholar 

  32. Maron BJ, Wolfson JK, Ciro E, Spirito P (1983) Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy.Am J Cardiol 51:189–194

    Google Scholar 

  33. Morganroth J, Maron BJ, Krovetz LJ, Henry WL, Epstein SE (1975) Electrocardiographic evidence of left ventricular hypertrophy in otherwise normal children: clarification by echocardiography.Am J Cardiol 35:278–281

    Google Scholar 

  34. Nakano H (1977) Left ventricular volume estimation in normal infants and children.Ann Paediatr Jpn 23:39–48

    Google Scholar 

  35. Norman JE, Levy D, Campbell G, Bailey JJ (1993) Improved detection of echocardiographic left ventricular hypertrophy using a new electrocardiogram algorithm.J Am Coll Cardiol 21:1680–1686

    Google Scholar 

  36. Oda T, Hamamoto K, Morinaga H (1982) Left ventricular hypertrophy in non-rheumatic myocarditis in children.Jpn Circ J 46:1235–1238

    Google Scholar 

  37. Onnasch DGW, Lange PE, Heintzen PH (1984) Left ventricular muscle volume in children and young adults.Pediatr Cardiol 5:101–106

    Google Scholar 

  38. Panza JA, Maron BJ (1989) Relation of electrocardiographic abnormalities to evolving left ventricular hypertrophy in hypertrophic cardiomyopathy during childhood.Am J Cardiol 63:1258–1265

    Google Scholar 

  39. Park MK, Guntheroth WG (1987)How to Read Pediatric ECGs, 2nd edn. Year Book, Chicago, pp 29–49

    Google Scholar 

  40. Radack KL, Rouan G, Hedges J (1986) The likelihood ratio: an improved measure for reporting and evaluating diagnostic test results.Arch Pathol Lab Med 110:689–693

    Google Scholar 

  41. Reichek N, Devereux RB (1981) Left ventricular hypertrophy: relationship of anatomic, echocardiographic, and electrocardiographic findings.Circulation 63:1391–1398

    Google Scholar 

  42. Reichek N, Devereux RB (1982) Reliable estimation of peak left ventricular systolic pressure by M-mode echographicdetermined end-diastolic relative wall thickness: identification of severe valvular aortic stenosis in adult patients.Am Heart J 103:202–209

    Google Scholar 

  43. Romhilt DW, Bove KE, Norris RJ, et al. (1969) A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy.Circulation 40:185–195

    Google Scholar 

  44. Sastroasmoro S, Madiyono B, Oesman IN (1991) Sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy in children with rheumatic heart disease.Paediatr Indonesia 31:233–244

    Google Scholar 

  45. Sokolow M, Lyon T (1949) The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads.Am Heart J 37:161–186

    Google Scholar 

  46. Surawicz B (1986) Electrocardiographic diagnosis of chamber enlargement.J Am Coll Cardiol 8:711–724

    Google Scholar 

  47. Thomaidis C, Varlamis G, Karamperis S (1988) Comparative study of the electrocardiogram of healthy fullterm and premature newborns.Acta Paediatr Scand 77:653–657

    Google Scholar 

  48. Toshima H, Koga Y, Kimura N (1977) Correlations between electrocardiographic, vectorcardiographic, and echocardiographic findings in patients with left ventricular overload.Am Heart J 94:547–556

    Google Scholar 

  49. Troy BL, Pombo J, Rackley CE (1972) Measurement of left ventricular wall thickness and mass by echocardiography.Circulation 45:602–611

    Google Scholar 

  50. Wagner HR, Weidman WH, Ellison RC, Miettinen OS (1977) Indirect assessment of severity in aortic stenosis.Circulation 56:120–123

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Non-Invasive Laboratories, Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 19104, Philadelphia, PA, USA

    M. A. Fogel, D. R. Lieb & M. A. Seliem

Authors
  1. M. A. Fogel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. R. Lieb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. A. Seliem
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fogel, M.A., Lieb, D.R. & Seliem, M.A. Validity of electrocardiographic criteria for left ventricular hypertrophy in children with pressure- or volume-loaded ventricles: Comparison with echocardiographic left ventricular muscle mass. Pediatr Cardiol 16, 261–269 (1995). https://doi.org/10.1007/BF00798059

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00798059

Key words

Search

Navigation