Udine Michelle L, Kaltman Jonathan R, Li Qianxi, Liu Jin, Sun Deyu, Cheung Man Ching, Sabouni Sam, Al Dulaimi Ahmed, Sable Craig
Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Philips Research North America, Cambridge, MA, USA.
Cardiol Young. 2022 Jun;32(6):855-860. doi: 10.1017/S1047951121004960. Epub 2022 Jan 6.
To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk.
This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2-18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age.
In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram.
African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.
评估收缩压百分位数、种族和体重指数与心电图及超声心动图所示左心室肥厚之间的关联，以确定高危人群。
这是一项回顾性横断面研究设计，利用数据分析工具（Tableau）合并了2003年至2020年的心电图和超声心动图数据库。通过定制查询，确定了2至18岁在同一天进行门诊心电图和超声心动图检查且有可用收缩压和身体测量数据的患者。排除患有冠心病、心肌病或心律失常诊断的病例。纳入了测量左心室质量（根据身高进行指数化）的超声心动图检查结果。主要结局是超声心动图所示左心室肥厚，定义为左心室质量指数大于年龄的第95百分位数。
在13539例患者队列中，6.7%的研究显示超声心动图存在左心室肥厚。收缩压百分位数>90%对于超声心动图所示左心室肥厚的敏感性为35%，特异性为82%。心电图所示左心室肥厚对超声心动图所示左心室肥厚的预测能力较差（敏感性为9%，特异性为92%）。非裔美国人种族（比值比1.31，95%置信区间=1.10，1.56，p = 0.002）、收缩压百分位数>95%（比值比=1.60，95%置信区间=1.34，1.93，p < 0.001）以及较高的体重指数（比值比=7.22，95%置信区间=6.23，8.36，p < 0.001）与超声心动图所示左心室肥厚独立相关。
非裔美国人种族、肥胖以及门诊血压测量显示的高血压是儿童左心室肥厚的独立危险因素。心电图在左心室肥厚筛查中的作用不大。
