Journal of electrocardiology · 2025
Age-related ECG milestones for rapid detection of congenital heart disease in children: A diagnostic test accuracy study.
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de Alencar José Nunes, Costa Isabela Rigolin, Monteiro Jade Arruda Motta, Furtado Julia Teuber, Sacre Rafael Carvalho, Guerra Christine Brasil, Knoblauch Wagner Santos, Felicioni Sandro Pinelli, Scheffer Matheus Kiszka, De Marchi Mariana Fuziy Nogueira
Аннотация
INTRODUCTION: Age-related shifts in pediatric ECG morphology are well described, yet the classic maturation milestones have never been tested head-to-head in a case-control design that yields diagnostic-accuracy metrics for congenital heart disease (CHD).
METHODS: In this retrospective diagnostic-accuracy study we reviewed 1637 12‑lead ECGs recorded in 2023 at a Brazilian tertiary cardiac center and its tele-ECG network. CHD was confirmed in 349 children; 1288 children with structurally normal hearts served as controls. An ECG was classified negative when R > S in V6 and an inferior axis were present and ≤ 35 months: no rsR' > 120 ms, pure-R, qR or pure-q in V1; 36-95 months: above criteria plus either R < S in V1 or R ≥ S but <6 mm; ≥ 96 months: above criteria plus S > R in V1. Any other pattern was deemed positive. Sensitivity, specificity and likelihood ratios (LR+, LR-) were calculated for three prespecified age strata.
RESULTS: Infants (1-35 months): sensitivity 67.5 % (95 % CI 60.4-74.5), specificity 88.8 % (86.0-91.7), LR+ 6.05, LR- 0.37. Transition pattern (36-95 months): sensitivity 66.7 % (57.4-76.0), specificity 87.0 % (83.7-90.2), LR+ 5.11, LR- 0.38. Adult-like pattern (≥ 96 months): sensitivity 71.6 % (61.8-81.4), specificity 90.5 % (87.6-93.4), LR+ 7.52, LR- 0.31.
CONCLUSIONS: A rapid age-tiered analysis delivers moderate rule-in (LR+ ≈ 5-8) and rule-out power (LR- ≈ 0.3-0.4). The tool is not a stand-alone diagnostic test. Full waveform interpretation remains essential once a tracing is flagged.
CLINICAL TRIAL REGISTRATION: None.
METHODS: In this retrospective diagnostic-accuracy study we reviewed 1637 12‑lead ECGs recorded in 2023 at a Brazilian tertiary cardiac center and its tele-ECG network. CHD was confirmed in 349 children; 1288 children with structurally normal hearts served as controls. An ECG was classified negative when R > S in V6 and an inferior axis were present and ≤ 35 months: no rsR' > 120 ms, pure-R, qR or pure-q in V1; 36-95 months: above criteria plus either R < S in V1 or R ≥ S but <6 mm; ≥ 96 months: above criteria plus S > R in V1. Any other pattern was deemed positive. Sensitivity, specificity and likelihood ratios (LR+, LR-) were calculated for three prespecified age strata.
RESULTS: Infants (1-35 months): sensitivity 67.5 % (95 % CI 60.4-74.5), specificity 88.8 % (86.0-91.7), LR+ 6.05, LR- 0.37. Transition pattern (36-95 months): sensitivity 66.7 % (57.4-76.0), specificity 87.0 % (83.7-90.2), LR+ 5.11, LR- 0.38. Adult-like pattern (≥ 96 months): sensitivity 71.6 % (61.8-81.4), specificity 90.5 % (87.6-93.4), LR+ 7.52, LR- 0.31.
CONCLUSIONS: A rapid age-tiered analysis delivers moderate rule-in (LR+ ≈ 5-8) and rule-out power (LR- ≈ 0.3-0.4). The tool is not a stand-alone diagnostic test. Full waveform interpretation remains essential once a tracing is flagged.
CLINICAL TRIAL REGISTRATION: None.