Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
HealthCore, Watertown, MA, USA.
Pediatr Cardiol. 2024 Jun;45(5):1055-1063. doi: 10.1007/s00246-024-03448-2. Epub 2024 Mar 23.
Pediatric ECG standards have been defined without echocardiographic confirmation of normal anatomy. The Pediatric Heart Network Normal Echocardiogram Z-score Project provides a racially diverse group of healthy children with normal echocardiograms. We hypothesized that ECG and echocardiographic measures of left ventricular (LV) dimensions are sufficiently correlated in healthy children to imply a clinically meaningful relationship. This was a secondary analysis of a previously described cohort including 2170 digital ECGs. The relationship between 6 ECG measures associated with LV size were analyzed with LV Mass (LVMass-z) and left ventricular end-diastolic volume (LVEDV-z) along with 11 additional parameters. Pearson or Spearman correlations were calculated for the 78 ECG-echocardiographic pairs with regression analyses assessing the variance in ECG measures explained by variation in LV dimensions and demographic variables. ECG/echocardiographic measurement correlations were significant and concordant in 41/78 (53%), though many were significant and discordant (13/78). Of the 6 ECG parameters, 5 correlated in the clinically predicted direction for LV Mass-z and LVEDV-z. Even when statistically significant, correlations were weak (0.05-0.24). R was higher for demographic variables than for echocardiographic measures or body surface area in all pairs, but remained weak (R ≤ 0.17). In a large cohort of healthy children, there was a positive association between echocardiographic measures of LV size and ECG measures of LVH. These correlations were weak and dependent on factors other than echocardiographic or patient derived variables. Thus, our data support deemphasizing the use of solitary, traditional measurement-based ECG markers traditionally thought to be characteristic of LVH as standalone indications for further cardiac evaluation of LVH in children and adolescents.
儿科心电图标准是在没有心脏超声确认正常解剖结构的情况下定义的。儿科心脏网络正常超声心动图 Z 评分项目为具有正常超声心动图的健康儿童提供了一个种族多样化的群体。我们假设在健康儿童中，心电图和左心室（LV）尺寸的超声心动图测量值具有足够的相关性，暗示了一种具有临床意义的关系。这是对以前描述的队列进行的二次分析，该队列包括 2170 份数字心电图。分析了与 LV 大小相关的 6 种心电图测量值与 LV Mass（LVMass-z）和左心室舒张末期容积（LVEDV-z）以及其他 11 个参数之间的关系。对于 78 对心电图-超声心动图对，计算了 Pearson 或 Spearman 相关性，并进行了回归分析，评估了 ECG 测量值的变化在多大程度上由 LV 尺寸和人口统计学变量的变化来解释。41/78（53%）对心电图/超声心动图测量值的相关性是显著且一致的，尽管许多是显著且不一致的（13/78）。在 6 个心电图参数中，5 个与 LV Mass-z 和 LVEDV-z 的临床预测方向相关。即使在统计学上显著，相关性也很弱（0.05-0.24）。在所有对中，与心电图测量值或体表面积相比，人口统计学变量的 R 值更高，但仍然较弱（R≤0.17）。在一个大型健康儿童队列中，LV 大小的超声心动图测量值与 LVH 的心电图测量值之间存在正相关。这些相关性较弱，并且取决于超声心动图或患者衍生变量以外的因素。因此，我们的数据支持不强调使用传统的基于单一测量的心电图标志物作为 LVH 的独立指征，这些标志物传统上被认为是 LVH 的特征，用于儿童和青少年进一步评估 LVH。
