The spatial QRS-T angle outperforms the Italian and Seattle ECG-based criteria for detection of hypertrophic cardiomyopathy in pediatric patients Daniel Cortez, MD, a, ⁎ Nandita Sharma, MD, b Jean Cavanaugh, PA-C, a Froilan Tuozo, PA-C, c Gwendolyn Derk, BS, d Emily Lundberg, BS, e Todd T. Schlegel, MD, f,1 Keith Weiner, MD, g Nafiz Kiciman, MD, c Juan Alejos, MD, e Bruce Landeck, MD, a Jamil Aboulhosn, MD, e Shelley Miyamoto, MD, a Anjan Batra, MD, c,2 Anthony C. McCanta, MD g,2 a Children’s Hospital Colorado/University of Colorado, Aurora, CO, USA b Cleveland Clinic Foundation, Cleveland, OH, USA c University of California at Irvine, Irvine, CA, USA d University of Illinois College of Medicine e University of California, Los Angeles, CA, USA f Nicollier-Schlegel SARL, Trélex, Switzerland g CHOC Children’s, Orange, CA, USA Abstract Introduction: The spatial peaks QRS-T angle has been shown to differentiate adult patients with hypertrophic cardiomyopathy (HCM) from controls. We hypothesized that the spatial peaks QRS-T angle would, in isolation, be more accurate than the Italian 12-lead ECG Pre-participation Screening criteria or the Seattle criteria for detecting hypertrophic cardiomyopathy (HCM) in pediatric patients. Methods: A retrospective study of pediatric patients with HCM compared to age and gender-matched control patients was undertaken. Significance, odds ratios, sensitivity and specificity of HCM detection of the visually derived spatial peaks QRS-T angle were compared to those of traditional 12-lead ECG criteria using: 1) Italy’s National Pre-participation Screening Programme criteria; and 2) described criteria from Seattle. Results: ECG results from 130 pediatric HCM patients (14.2 ± 4.4 years) were compared to 470 control patients (normal echocardiograms, mean age 13.4 ± 4.6 years). Mean ± standard deviation (SD) values for spatial peaks QRS-T angles were 120.4 ± 40.7 and 21.3 ± 13.7 degrees for HCM and controls, respectively (P b 0.001). A spatial peaks QRS-T angle cutoff value of N 54.9 degrees yielded greater sensitivity and specificity (93.1% and 98.7%, respectively) for detecting HCM over ECG criteria from Italy (68.5% and 48.1%, respectively) or Seattle (64.6% and 78.9%, respectively) with odds ratios at 1039.70 (95% CI 363.03 to 2977.67), 2.01 (95% CI 1.33 to 3.04) and 6.84 (4.49-10.44), respectively. Conclusion: In our cohort, a visually derived spatial peaks QRS-T angle has increased sensitivity and specificity for detection of HCM in pediatric patients compared to currently utilized Italian or Seattle ECG criteria. © 2015 Elsevier Inc. All rights reserved. Keywords: Vectorcardiography; Screening; Seattle criteria; Italian criteria Introduction Hypertrophic cardiomyopathy (HCM) is a genetic condition with reported incidence up to 1:500. It is an insidious killer and the number one cause of sudden cardiac death in children and young adults [1]. Screening for HCM has sometimes involved use of 12-lead electrocardiography (ECG). In such circumstances, if left ventricular hypertrophy (LVH) is noted on a screening ECG by specific voltage criteria, or if changes in the Q, T, or ST-T waves are noted, then a follow-up echocardiogram may be indicated. Two screening criteria employed today are the Italian National Pre-participation screening criteria as well as the Seattle screening criteria [2,3]. However, neither of these screening criteria incorporates recent advances in ECG technology, for example results from vectorcardiographic parameters that can now be automatically derived from standard 12-lead ECG recordings to improve both diagnostic [4–6] and prognostic [7–15] performance. The spatial QRS-T angle has been shown to improve detection of Available online at www.sciencedirect.com ScienceDirect Journal of Electrocardiology 48 (2015) 826 – 833 www.jecgonline.com ⁎ Corresponding author at: Children’s Hospital of Colorado, Department of Cardiology, 13123 E. 16th Ave., B100, Aurora, CO, 80045. 1 Ownership Interest; Modest; Nicollier-Schlegel SARL. 2 Contributed equally as senior authors. http://dx.doi.org/10.1016/j.jelectrocard.2015.07.016 0022-0736/© 2015 Elsevier Inc. All rights reserved.