Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1052-1055 (doi:10.1542/peds.2005-2985)
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ARTICLE

Electrocardiography in the Diagnosis of Right Ventricular Hypertrophy in Children

Michael D. Puchalski, MDa, John S. Lozier, MDb, David J. Bradley, MDa, L. LuAnn Minich, MDa and Lloyd Y. Tani, MDa

a Department of Pediatrics, Primary Children's Medical Center and University of Utah School of Medicine, Salt Lake City, Utah
b Department of Pediatrics, University of Michigan, Ann Arbor, Michigan

OBJECTIVE. Although the electrocardiogram is commonly obtained in the evaluation of patients with pulmonary hypertension, its value as a screening test for right ventricular hypertrophy or pulmonary hypertension is unclear. Therefore, we sought to determine the value of an electrocardiogram in the diagnosis of right ventricular hypertrophy using echocardiography as the gold standard.

METHODS. We identified children without congenital heart disease who underwent evaluation for suspected pulmonary hypertension that included both an electrocardiogram and echocardiography within a specified time frame.

RESULTS. A total of 76 echocardiography-electrocardiogram pairs for pulmonary hypertension were identified. Although there was a significant relationship between electrocardiogram and echocardiography evidence of right ventricular hypertrophy, the sensitivity of an electrocardiogram in diagnosing echocardiography-documented right ventricular hypertrophy was only 69%, and the positive predictive value was 67%. There was no relationship between electrocardiogram changes and Doppler tricuspid regurgitation gradient.

CONCLUSION. Despite a statistically significant relationship between an electrocardiogram and echocardiography in the diagnosis of right ventricular hypertrophy, an electrocardiogram has limited value as a screening tool for right ventricular hypertrophy because of its relatively low sensitivity and positive predictive value.

Key Words: electrocardiogram • right ventricular hypertrophy • pulmonary hypertension • echocardiography

Abbreviations: RV—right ventricular • RVH—right ventricular hypertrophy • ECG—electrocardiography • TR—tricuspid regurgitation

Accepted Apr 3, 2006.


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