The Neonatal QRS Complex and Its Association with Left Ventricular Mass

Author:

Molin Julie,Hartmann Joachim,Pærregaard Maria Munk,Thygesen Caroline Boye,Sillesen Anne-Sophie,Raja Anna Axelsson,Vøgg Ruth Ottilia Birgitta,Iversen Kasper Karmark,Bundgaard Henning,Christensen Alex Hørby

Abstract

AbstractTo evaluate QRS complex features during the first month of life and the association with echocardiographic measurements of left ventricular mass in neonates. Prospective cohort study of neonates with electrocardiography (ECG) and echocardiography performed during the first month of life. Left ventricular mass index (LVMI) was determined by echocardiography and the correlation with electrocardiographic markers of LVMI outliers (≥ 98th percentile) were analyzed. We included 17,450 neonates (52% boys; median age at examination 11 days) and found an increase in median QRS duration and LVMI during the first month of life (54 vs. 56 ms and 24.7 vs. 28.6 g/m2 at days 0–4 and 25–30, respectively; both p < 0.001). All investigated ECG features (QRS duration, QRS area in V1/V6, maximum amplitudes of S-V1/R-V6, and the Sokolow–Lyon voltage product) showed no to low correlation with LVMI, resulting in low sensitivities (0–9.0%), but high specificities (97.2–98.1%), and area under the curve values close to the identity line (0.49–0.61) for identifying LVMI outliers. Adjustment of outlier definition for LVMI and threshold for QRS features had no significant effect on sensitivity. We present reference values for QRS complex features and their association with LVMI in neonates from a large, unselected, population-based cohort. The QRS complex gradually evolved during the first month of life but had a low correlation with LVMI. Our results indicate a poor diagnostic value of using ECG features to identify LVMI outliers in neonates.Trial Registry Copenhagen Baby Heart, NCT02753348, https://clinicaltri-als.gov/ct2/show/NCT02753348?cond=Copenhagen+Baby+Heart&draw=2&rank=1, deidentified individual participant data will not be made available.

Funder

The Research Council at Herlev-Gentofte Hospital

The Novo Nordisk Foundation

The Toyota Foundation Denmark

The Candy Foundation

The Danish Heart Foundation,

The Capital Regions Research Council.

The Independent Research Fund Denmark

Copenhagen University

Publisher

Springer Science and Business Media LLC

Subject

Cardiology and Cardiovascular Medicine,Pediatrics, Perinatology and Child Health

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