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Comparison of Left Ventricular Hypertrophy by Electrocardiography and Echocardiography in Children Using Analytics Tool

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Abstract

Left ventricular hypertrophy (LVH) is a common finding on pediatric electrocardiography (ECG) leading to many referrals for echocardiography (echo). This study utilizes a novel analytics tool that combines ECG and echo databases to evaluate ECG as a screening tool for LVH. SQL Server 2012 data warehouse incorporated ECG and echo databases for all patients from a single institution from 2006 to 2016. Customized queries identified patients 0–18 years old with LVH on ECG and an echo performed within 24 h. Using data visualization (Tableau) and analytic (Stata 14) software, ECG and echo findings were compared. Of 437,699 encounters, 4637 met inclusion criteria. ECG had high sensitivity (≥ 90%) but poor specificity (43%), and low positive predictive value (< 20%) for echo abnormalities. ECG performed only 11–22% better than chance (AROC = 0.50). 83% of subjects with LVH on ECG had normal left ventricle (LV) structure and size on echo. African-Americans with LVH were least likely to have an abnormal echo. There was a low correlation between V6R on ECG and echo-derived Z score of left ventricle diastolic diameter (r = 0.14) and LV mass index (r = 0.24). The data analytics client was able to mine a database of ECG and echo reports, comparing LVH by ECG and LV measurements and qualitative findings by echo, identifying an abnormal LV by echo in only 17% of cases with LVH on ECG. This novel tool is useful for rapid data mining for both clinical and research endeavors.

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Authors and Affiliations

  1. Division of Cardiology, Children’s National Health System, Washington, DC, USA

    Lauren Tague, Justin Wiggs, Elizabeth Sherwin & Craig Sable

  2. Philips Research North America, Cambridge, MA, USA

    Qianxi Li

  3. Division of Biostatistics and Study Methods, Children’s National Health System, Washington, DC, USA

    Robert McCarter

  4. Division of Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    Jacqueline Weinberg

  5. Department of Cardiology, Children’s National Health System, 111 Michigan Avenue NW, Suite WW3-200, Washington, DC, 20010, USA

    Lauren Tague

Authors
  1. Lauren Tague
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  2. Justin Wiggs
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  3. Qianxi Li
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  5. Elizabeth Sherwin
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  6. Jacqueline Weinberg
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  7. Craig Sable
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Correspondence to Lauren Tague.

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A collaborator contractual agreement has been completed and signed between Philips Healthcare, a division of Philips Electronics North America Corporation, and Children’s National Health System, division of cardiology. There exist no financial interests for the investigator or provider institutions in the outcome of the research.

Research Involving Human and Animal Participants

This article does not contain any studies with human participants or animals performed by any of the authors.

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Tague, L., Wiggs, J., Li, Q. et al. Comparison of Left Ventricular Hypertrophy by Electrocardiography and Echocardiography in Children Using Analytics Tool. Pediatr Cardiol 39, 1378–1388 (2018). https://doi.org/10.1007/s00246-018-1907-7

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  • DOI: https://doi.org/10.1007/s00246-018-1907-7

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