An electrocardiographic score to predict pulmonary hypertension in children with atrial septal defect

Murni, Indah K. and Kato, Taichi and Wirawan, Muhammad Taufik and Arafuri, Nadya and Hermawan, Kristia and Hartopo, Anggoro Budi and Anggrahini, Dyah Wulan and Nugroho, Sasmito and Noormanto, Noormanto and Emoto, Noriaki and Dinarti, Lucia Kris (2023) An electrocardiographic score to predict pulmonary hypertension in children with atrial septal defect. BMC Pediatrics, 23 (1): 288. ISSN 14712431

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Abstract

Background: In limited resource settings, identification of factors that predict the occurrence of pulmonary hypertension(PH) in children with atrial septal defect(ASD) is important to decide which patients should be prioritized for defect closure to prevent complication. Echocardiography and cardiac catheterization are not widely available in such settings. No scoring system has been proposed to predict PH among children with ASD. We aimed to develop a PH prediction score using electrocardiography parameters for children with ASD in Indonesia. Methods: A cross-sectional study reviewing medical record including ECG record was conducted among all children with newly diagnosed isolated ASD admitted to Dr Sardjito Hospital in Yogyakarta, Indonesia during 2016–2018. Diagnosis of ASD and PH was confirmed through echocardiography and/or cardiac catheterization. Spiegelhalter Knill-Jones approach was used to develop PH prediction score. Accuracy of prediction score was performed using a receiver operating characteristic (ROC) curve. Results: Of 144 children, 50(34.7) had PH. Predictors of pulmonary hypertension were QRS axis ≥120°, P wave ≥ 3 mm at lead II, R without S at V1, Q wave at V1, right bundle branch block (RBBB), R wave at V1, V2 or aVR > normal limit and S wave at V6 or lead I > normal limit. ROC curve from prediction scores yielded an area under the curve (AUC) 0.908(95 CI 0.85–0.96). Using the cut-off value 3.5, this PH prediction score had sensitivity of 76(61.8–86.9), specificity 96.8(91.0-99.3), positive predictive value 92.7(80.5–97.5), negative predictive value 88.4(82.2–92.6), and positive likelihood ratio 23.8(7.7–73.3). Conclusions: A presence of PH in children with ASD can be predicted by the simple electrocardiographic score including QRS axis ≥120°, P wave ≥3 mm at lead II, R without S at V1, Q wave at V1, RBBB, R wave at V1, V2 or aVR > normal limit and S wave at V6 or lead I > normal limit. A total score ≥ 3.5 shows a moderate sensitivity and high specificity to predict PH among children with ASD. © 2023, The Author(s).

Item Type: Article
Additional Information: Cited by: 0; All Open Access, Gold Open Access, Green Open Access
Uncontrolled Keywords: Bundle-Branch Block; Child; Cross-Sectional Studies; Electrocardiography; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Nijmegen Breakage Syndrome; adolescent; area under the curve; Article; child; controlled study; cross-sectional study; diagnostic accuracy; disease association; electrocardiography; electronic medical record; female; heart atrium septum defect; heart catheterization; heart right bundle branch block; hospital admission; human; Indonesia; infant; male; prediction; predictive value; preschool child; pulmonary hypertension; receiver operating characteristic; school child; scoring system; sensitivity and specificity; Spiegelhalter Knill Jones approach; transthoracic echocardiography; complication; electrocardiography; heart bundle branch block; Nijmegen breakage syndrome; pulmonary hypertension
Subjects: R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine, Public Health and Nursing > Public Health and Nutrition
Depositing User: Ani PURWANDARI
Date Deposited: 17 May 2024 06:12
Last Modified: 17 May 2024 06:12
URI: https://ir.lib.ugm.ac.id/id/eprint/1181

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