Echocardiographic Z-Score to Predict Pulmonary-Systemic Flow Ratio in Children With Atrial Septal Defect.

Area of Science:

• Pediatric Cardiology
• Echocardiography
• Congenital Heart Disease

Background:

• Atrial septal defect (ASD) is a common congenital heart condition.
• The relationship between right heart enlargement and pulmonary-to-systemic flow ratio (Qp/Qs) in pediatric ASD patients is not fully understood.
• Accurate assessment of Qp/Qs is crucial for guiding treatment decisions.

Purpose of the Study:

• To evaluate echocardiographic Z-scores of the right heart in children with ASD.
• To determine if these Z-scores can predict the pulmonary-to-systemic flow ratio (Qp/Qs).
• To identify a potential non-invasive marker for assessing Qp/Qs in pediatric ASD.

Main Methods:

• Retrospective study of 175 children with isolated ASD.
• Echocardiographic parameters were measured and converted to Z-scores.
• Comparison of echocardiographic Z-scores with cardiac catheterization-derived Qp/Qs (cQp/Qs).

Main Results:

• The average right ventricular Z-score (ARV) showed the strongest correlation with cQp/Qs (r=0.63).
• An ARV cut-off of +2.0 effectively predicted a cQp/Qs ≥1.5 (AUC 0.85).
• Regression-predicted cQp/Qs also correlated well with measured cQp/Qs (r=0.63).

Conclusions:

• The average right ventricular Z-score (ARV) is a reliable non-invasive marker for assessing cQp/Qs in children with ASD.
• ARV can aid in determining the indication for ASD closure.
• Echocardiography offers a valuable tool for risk stratification in pediatric ASD.