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Limited Relationship Between Echocardiographic Measures and Electrocardiographic Markers of Left Ventricular Size in Healthy Children

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Abstract

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). R2 was higher for demographic variables than for echocardiographic measures or body surface area in all pairs, but remained weak (R2 ≤ 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.

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Funding

The study was supported by grants (HL135680, HL135685, HL135683, HL135689, HL135646, HL135665, HL135678, HL135682, HL135666, HL135691, HL068270) from the National Heart, Lung, and Blood Institute, NIH. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the National Heart, Lung, and Blood Institute, no other disclosures.

Author information

Author notes

  1. Sabrina S. Tsao

    Present address: Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong

  2. Joseph Mahgerefteh

    Present address: Mount Sinai Kravis Children’s Heart Center, New York, USA

Authors and Affiliations

  1. Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Mark E. Alexander & John K. Triedman

  2. HealthCore, Watertown, MA, USA

    Russell Gongwer & Felicia L. Trachtenberg

  3. University of Utah, Salt Lake City, UT, USA

    L. LuAnn Minich, Martin Tristani-Firouzi & Thomas Pilcher

  4. NIH, Bethesda, USA

    Jonathan R. Kaltman

  5. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Richard J. Czosek

  6. CS Mott Children’s Hospital, Ann Arbor, MI, USA

    Martin J. LaPage

  7. Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Sabrina S. Tsao

  8. Vanderbilt University, Nashville, TN, USA

    Andrew E. Radbill

  9. Columbia University Irving Medical Center, New York, NY, USA

    Michael P. DiLorenzo

  10. Medical College of Wisconsin, Milwaukee, WI, USA

    Joshua R. Kovach

  11. The Hospital for Sick Children, Toronto, ON, USA

    Elizabeth A. Stephenson

  12. CHOP, Philadelphia, PA, USA

    Christopher Janson

  13. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Chad Mao

  14. Seattle Children’s Hospital, Seattle, WA, USA

    Jack C. Salerno

  15. Children’s Hospital at Montefiore, New York, NY, USA

    Bradley C. Clark & Joseph Mahgerefteh

  16. Indiana University School of Medicine, Indianapolis, IN, USA

    Tiffanie R. Johnson

  17. Texas Children’s Hospital, Houston, TX, USA

    Jeff J. Kim & Santiago O. Valdes

  18. Medical University of South Carolina, Charleston, SC, USA

    Nicole Cain & Lanier Jackson

  19. St. Luke’s Health System, Boise, ID, USA

    Elizabeth V. Saarel

  20. Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, OH, USA

    Elizabeth V. Saarel

Authors
  1. Mark E. Alexander
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  2. Russell Gongwer
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  18. Bradley C. Clark
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  20. Thomas Pilcher
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  21. Tiffanie R. Johnson
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  22. Jeff J. Kim
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  23. Santiago O. Valdes
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  24. Nicole Cain
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  25. Lanier Jackson
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  26. Elizabeth V. Saarel
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For the Pediatric Heart Network Investigators

Contributions

MEA prepared the main manuscript and tables with RG and FLT performing statistical analysis and preparing the figures. The overall study design was developed by LM, JK, EVS, MEA, RC and JT and approved by all members of the writing committee prior to analysis. MTF, TP and EVS managed the ECG core lab and LM managed the echocardiographic core lab. Additional editorial review was provided by the remaining members of the writing committee as well as written formal acceptance of the manuscript. In addition the PHN committee for publications reviewed and approved the manuscript.

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Correspondence to Mark E. Alexander.

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Alexander, M.E., Gongwer, R., Trachtenberg, F.L. et al. Limited Relationship Between Echocardiographic Measures and Electrocardiographic Markers of Left Ventricular Size in Healthy Children. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03448-2

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