The spatial QRS-T angle outperforms the Italian and Seattle ECG-based criteria for detection of hypertrophic cardiomyopathy in pediatric patients

•We compared the Italian and Seattle criteria to the spatial QRS-T angle to identify patients with hypertrophic cardiomyopathy.•We utilized a method for determining the spatial QRS-T angle based on any available ECG, paper or electronic.•We demonstrate the improved performance of the spatial QRS-T angle over the other two criteria.•We demonstrate ventricular tachycardia predictive power in a small subset of hypertrophic cardiomyopathy patients.

IntroductionThe 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.MethodsA 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.ResultsECG 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 < 0.001). A spatial peaks QRS-T angle cutoff value of > 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.ConclusionIn 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.