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Echocardiograms are considered the gold-standard for diagnosis, but given their wider access and lower economic cost, electrocardiograms (ECGs) may be useful in identifying patients who would benefit from further investigation. This study investigates the utility of ECG criteria to diagnose LAE in pediatric patients. A retrospective chart review (n\u2009=\u2009492) was conducted in patients whose echocardiograms demonstrated LAE by left atrial indexed diameter z-score \u22652.0 and\/or increased left atrial to aortic root ratio at various cutoffs (\u22651.4, \u22651.6, \u22651.8). ECG criteria studied included: (1) P wave \u2265110 msec, (2) P mitrale \u226540 msec, in LII (3) terminal negative P wave deflection in lead V1\u2009&gt;\u200940 msec, and (4) P\/PR segment &gt;1.6 in lead II. Sensitivity, specificity, Cohen\u2019s Kappa coefficient (\u03ba), and ROC curves were calculated. A combination of P mitrale \u226540 msec and terminal negative P wave deflection in lead V1\u2009&gt;\u200940 msec yielded the greatest agreement (\u03ba\u2009=\u20090.221, 95%CI 0.060\u20130.382), but all ECG criteria used to diagnose LAE had poor diagnostic value (AUC\u2009&lt;\u20090.60). The present ECG criteria should not be used to diagnose LAE in the absence of an echocardiogram and findings should be considered in the context of clinical symptoms.<\/jats:p>","DOI":"10.1038\/s41598-020-66987-7","type":"journal-article","created":{"date-parts":[[2020,6,22]],"date-time":"2020-06-22T06:03:36Z","timestamp":1592805816000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Accuracy of Electrocardiography and Agreement with Echocardiography in the Diagnosis of Pediatric Left Atrial Enlargement"],"prefix":"10.1038","volume":"10","author":[{"given":"Charis","family":"Ng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton R.","family":"Budhram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mu","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narayanaswamy","family":"Balakrishnan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapas","family":"Mondal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,6,22]]},"reference":[{"key":"66987_CR1","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1093\/ejechocard\/jeq175","volume":"12","author":"GG Blume","year":"2011","unstructured":"Blume, G. 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