Umamy Kunti N, Martiana Astri K, Myrtha Risalina, Irnizarifka Irnizarifka, Nursidiq Alfa A
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia.
Egypt Heart J. 2025 Jan 10;77(1):8. doi: 10.1186/s43044-024-00596-x.
Precapillary pulmonary hypertension (PH) as complication in atrial septal defect (ASD) is closely related to right heart hemodynamics, such as right atrial pressure (RAP) and pulmonary vascular resistance (PVR). Right heart catheterization (RHC) as the gold standard for their measurement is invasive and not widely available in Indonesia. Electrocardiography (ECG) was proposed to be alternative in this matter.
This is a retrospective observational study with cross-sectional design. We collected data and measured ECG parameters of secundum ASD patients who underwent elective RHC from May 2019 until November 2023. We compared several ECG parameters based on RAP (< 8 and ≥ 8 mmHg) and PVR (< 5 and ≥ 5 WU).
Eighty-three patients were included. The R was the only ECG marker that showed significant difference based on RAP (AUC 0.639, sensitivity 61.7%, specificity 61.1%, p = 0.030) and PVR (AUC 0.801, sensitivity 73.2%, specificity 81%, p < 0.001). Several ECG parameters were found significantly different based on PVR value only, namely S (AUC 0.773, sensitivity 80.5%, specificity 71.4%, p < 0.001), S (AUC 0.823, sensitivity 80.5%, specificity 81%, p < 0.001), right ventricular Sokolow-Lyon index (RVSLI) (AUC 0.841, sensitivity 82.9%, specificity 83.3%, p < 0.001), R/S (sensitivity 97.6%, specificity 16.7%, p = 0.031) as well as right ventricular strain (sensitivity 87.8%, specificity 69%, p < 0.001). Multivariate regression analysis showed RVSLI (OR 15.66 (4.46-55.02), CI 95%) and right ventricular strain pattern (OR 9.23 (2.43-35.14), CI 95%) had the best predictive value for PVR ≥ 5 WU.
In adults with secundum ASD, several ECG markers have potential role in predicting PVR ≥ 5 WU with satisfying sensitivity and specificity, but not in predicting RAP.
毛细血管前性肺动脉高压（PH）作为房间隔缺损（ASD）的并发症，与右心血流动力学密切相关，如右心房压力（RAP）和肺血管阻力（PVR）。右心导管检查（RHC）作为测量它们的金标准具有侵入性，在印度尼西亚并不广泛可用。心电图（ECG）被提议作为此事的替代方法。
这是一项采用横断面设计的回顾性观察性研究。我们收集了2019年5月至2023年11月接受择期RHC的继发孔型ASD患者的数据并测量了其ECG参数。我们根据RAP（<8和≥8 mmHg）和PVR（<5和≥5 WU）比较了几个ECG参数。
纳入了83例患者。R是唯一基于RAP（AUC 0.639，敏感性61.7%，特异性61.1%，p = 0.030）和PVR（AUC 0.801，敏感性73.2%，特异性81%，p < 0.001）显示出显著差异的ECG标志物。发现几个ECG参数仅基于PVR值有显著差异，即S（AUC 0.773，敏感性80.5%，特异性71.4%，p < 0.001）、S（AUC 0.823，敏感性80.5%，特异性81%，p < 0.001）、右心室索科洛夫-里昂指数（RVSLI）（AUC 0.841，敏感性82.9%，特异性83.3%，p < 0.001）、R/S（敏感性97.6%，特异性16.7%，p = 0.031）以及右心室应变（敏感性87.8%，特异性69%，p < 0.001）。多因素回归分析显示RVSLI（OR 15.66（4.46 - 55.02），95%CI）和右心室应变模式（OR 9.23（2.43 - 35.14），95%CI）对PVR≥5 WU具有最佳预测价值。
在继发孔型ASD的成人患者中，几个ECG标志物在预测PVR≥5 WU方面具有潜在作用，敏感性和特异性令人满意，但在预测RAP方面则不然。
