Electrocardiographic markers predict hemodynamic parameters in adults with uncorrected secundum atrial septal defect

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_V1 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_V5 (AUC 0.773, sensitivity 80.5%, specificity 71.4%, p < 0.001), S_V6 (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_V1 (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.