Shen Lei, Liu Jian, Li Jin-Kang, Xu Meng, Yuan Lang, Zhang Guo-Qin, Wang Jian-Yi, Huang Yu-Juan
Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China.
Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China.
Pediatr Cardiol. 2018 Jun;39(5):1031-1035. doi: 10.1007/s00246-018-1857-0. Epub 2018 Mar 22.
The purpose of this study was to test the hypothesis that the incidence of crochetage on the R wave in inferior limb leads can be used for the diagnosis of pediatric secundum atrial septal defect (ASD). Two hundred fifty-six children with secundum ASD (case cohort) and 256 age- and gender-matched children without heart disease (control cohort) were included in the study. Statistical analyses were performed to test the relationship between the ASD and the crochetage on the R wave with a single lead and three leads, respectively. The impact of incomplete right bundle branch block (IRBBB) and ASD diameter (≥ 5 and < 5 mm) on ASD diagnosis were also explored. Crochetage on the R wave was observed in all three inferior limb leads on 28.13% (72/256, 28 with IRBBB) of subjects with secundum ASD, while it was seen in only 2.73% (7/256, one with IRBBB) of control subjects (P < 0.001). Subgroup analysis showed that the incidence of R wave crochetage correlated with ASD size in both the single inferior limb lead (26.14%, 23/88 on ASD ≥ 5 mm vs. 10.71%, 18/168 on ASD < 5 mm; P = 0.001) and all three inferior limb leads (44.32%, 39/88 on ASD ≥ 5 mm vs. 19.64%, 33/168 on ASD < 5 mm; P < 0.001). Our findings suggest that crochetage on the R wave in inferior limb leads can serve as an independent marker for ASD diagnosis.
下肢导联R波上的切迹发生率可用于小儿继发孔型房间隔缺损（ASD）的诊断。本研究纳入了256例继发孔型ASD患儿（病例队列）和256例年龄及性别匹配的无心脏病儿童（对照队列）。分别进行统计分析以检验ASD与单导联及三导联R波切迹之间的关系。还探讨了不完全性右束支传导阻滞（IRBBB）和ASD直径（≥5和<5mm）对ASD诊断的影响。继发孔型ASD患者中28.13%（72/256，28例合并IRBBB）的所有三个下肢导联均观察到R波切迹，而对照受试者中仅2.73%（7/256，1例合并IRBBB）观察到R波切迹（P<0.001）。亚组分析显示，单一下肢导联（ASD≥5mm时为26.14%，23/88；ASD<5mm时为10.71%，18/168；P=0.001）和所有三个下肢导联（ASD≥5mm时为44.32%，39/88；ASD<5mm时为19.64%，33/168；P<0.001）的R波切迹发生率均与ASD大小相关。我们的研究结果表明，下肢导联R波上的切迹可作为ASD诊断的独立标志物。
