The spatial QRS-T angle outperforms the Italian and Seattle ECG-based criteria for detection of hypertrophic cardiomyopathy in pediatric patients

Daniel Cortez, Nandita Sharma, Jean Cavanaugh, Froilan Tuozo, Gwendolyn Derk, Emily Lundberg, Todd T. Schlegel, Keith Weiner, Nafiz Kiciman, Juan Alejos, Bruce Landeck, Jamil Aboulhosn, Shelley Miyamoto, Anjan Batra, Anthony C. McCanta

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Introduction The spatial peaks QRS-T angle has been shown to differentiate adult patients with hypertrophic cardiomyopathy (HCM) from controls. We hypothesized that the spatial peaks QRS-T angle would, in isolation, be more accurate than the Italian 12-lead ECG Pre-participation Screening criteria or the Seattle criteria for detecting hypertrophic cardiomyopathy (HCM) in pediatric patients. Methods A retrospective study of pediatric patients with HCM compared to age and gender-matched control patients was undertaken. Significance, odds ratios, sensitivity and specificity of HCM detection of the visually derived spatial peaks QRS-T angle were compared to those of traditional 12-lead ECG criteria using: 1) Italy's National Pre-participation Screening Programme criteria; and 2) described criteria from Seattle. Results ECG results from 130 pediatric HCM patients (14.2 ± 4.4 years) were compared to 470 control patients (normal echocardiograms, mean age 13.4 ± 4.6 years). Mean ± standard deviation (SD) values for spatial peaks QRS-T angles were 120.4 ± 40.7 and 21.3 ± 13.7 degrees for HCM and controls, respectively (P < 0.001). A spatial peaks QRS-T angle cutoff value of > 54.9 degrees yielded greater sensitivity and specificity (93.1% and 98.7%, respectively) for detecting HCM over ECG criteria from Italy (68.5% and 48.1%, respectively) or Seattle (64.6% and 78.9%, respectively) with odds ratios at 1039.70 (95% CI 363.03 to 2977.67), 2.01 (95% CI 1.33 to 3.04) and 6.84 (4.49-10.44), respectively. Conclusion In our cohort, a visually derived spatial peaks QRS-T angle has increased sensitivity and specificity for detection of HCM in pediatric patients compared to currently utilized Italian or Seattle ECG criteria.

Original languageEnglish (US)
Pages (from-to)826-833
Number of pages8
JournalJournal of Electrocardiology
Volume48
Issue number5
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Keywords

  • Italian criteria
  • Screening
  • Seattle criteria
  • Vectorcardiography

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