Cardiomyopathy
Correlation of Precordial Voltages to Left Ventricular Mass on Echocardiogram in Adolescent Patients With Hypertrophic Cardiomyopathy Compared With that in Adolescent Athletes

https://doi.org/10.1016/j.amjcard.2015.01.025Get rights and content

Electrocardiograms continue to be part of screening programs for athletes and familial hypertrophic cardiomyopathy (HC). Whether electrocardiographic (ECG) findings of left ventricular (LV) hypertrophy can distinguish between healthy populations and those with HC remains unclear. We sought to (1) analyze the relation between ECG voltage and LV mass in patients with HC and (2) evaluate ECG characteristics of patients with phenotypical HC. Retrospective cohort of patients with HC aged 13 to 18 years. Relation between ECG voltages (RV6, SV1, and RV6 + SV1) and echocardiogram measurements of LV mass was investigated using smoothing splines to display relations and compared with those in a prospectively obtained population of adolescents. Frequency of abnormal LV voltages and nonvoltage ECG changes (Q waves, T-wave changes, and ST changes) were analyzed for association with HC. Fifty-three patients with HC (72% men) were age and gender matched to 104 control patients. Smoothing splines demonstrated that parabolic rather than linear relations existed between LV mass and SV1, RV6, and RV6 + SV1 in patients with HC and not the control cohort. LV hypertrophy by ECG voltage criteria was present in 34% of patients with HC and associated with poor sensitivity (29%). In patients with HC, 56% demonstrated nonvoltage ECG abnormalities and were associated with improved sensitivity (68%) and high specificity (94%). In conclusion, there is a parabolic relation between LV voltages and LV mass in adolescents with HC that may lead to “pseudonormalization.” Voltage abnormalities were associated with poor sensitivity, whereas nonvoltage criteria were associated with improved sensitivity with high specificity.

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Methods

This was a retrospective cohort study of pediatric patients evaluated for HC. This study was approved by the Cincinnati Children's Hospital Internal Review Board (study# 2013-4304). Consecutive adolescent patients aged 13 to 18 years with a history of HC from January 1, 2003, to June 30, 2013, were included. An electrocardiogram, echocardiogram, and genetic testing were part of the evaluation. Genetic testing was completed between 2008 and 2012. Patients with a gene positive family history of

Results

There were 97 patients evaluated for HC during the study period, of which 52 met criteria. Eleven patients were excluded because they were genotype and phenotype negative. Thirty-four patients were excluded because genetic testing was not completed and phenotype negative. Patient demographics are demonstrated in Table 1. Mean age was 16 years (13 to 18). Postevaluation HC classification was 21 (40%) gene+/phen+, 12 (23%) gene+/phen−, 10 (19%) gene−/phen+, and 9 (17%) genotype unknown but

Discussion

Electrocardiograms continue to be part of athletic screening programs, as well as screening for HC, although whether ECG findings of LV hypertrophy can be used to distinguish between healthy populations and those with HC remains unclear. This study finds that there is a parabolic relation between ECG LV precordial voltages and LV mass in the phenotype-positive adolescents not expressed in adolescent athlete controls. LV hypertrophy by ECG voltage criteria demonstrated poor sensitivity and was

Disclosures

The authors have no conflicts of interest to disclose.

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