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Updated: Jun 26, 2026

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
07:11

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

Published on: October 28, 2020

Diagnostic Value of the Terminal D1S + D3R Pattern for Detecting Right Ventricular Dilatation in Patients with Atrial

Rauf Avcı1, Fatih Han Kumtaş2

  • 1Turkish Ministry of Health Antalya Training and Research Hospital, 07100 Antalya, Turkey.

Journal of Cardiovascular Development and Disease
|June 25, 2026
PubMed

Insights

The terminal D1S + D3R electrocardiogram (ECG) pattern is linked to right ventricular (RV) dilatation in adults with atrial septal defect (ASD). This ECG finding may aid in screening but does not replace echocardiography for assessing RV involvement.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrocardiography

Background:

  • Atrial septal defect (ASD) is a common condition in adults, often leading to chronic right ventricular (RV) volume overload and remodeling.
  • Electrocardiography (ECG) can potentially serve as a supplementary screening tool alongside echocardiography for evaluating RV status in ASD patients.

Purpose of the Study:

  • To investigate the association between the terminal D1S + D3R ECG pattern and structural/hemodynamic right heart abnormalities in adult secundum ASD.
  • To determine if the terminal D1S + D3R ECG pattern can predict right heart involvement in adult atrial septal defects.

Main Methods:

  • Retrospective analysis of 161 adult patients diagnosed with secundum ASD.
  • Assessment of right heart involvement using pulmonary-to-systemic flow ratio (Qp/Qs ≥ 1.5) and RV/left ventricular (RV/LV) ratio > 1.
  • Evaluation of ECG parameters, including the terminal D1S + D3R pattern, using multivariable logistic regression and ROC analyses.

Main Results:

  • The terminal D1S + D3R ECG pattern was independently associated with RV dilatation (OR: 9.90, p < 0.001).
  • The pattern demonstrated strong discriminatory performance for RV dilatation (AUC: 0.881).
  • Pulmonary artery pressure and ASD diameter were associated with increased Qp/Qs, but the D1S + D3R pattern was not.

Conclusions:

  • A positive terminal D1S + D3R ECG pattern is significantly associated with RV dilatation in adults with secundum ASD.
  • This ECG pattern may function as a practical, adjunctive screening marker for RV dilatation in this population.
  • Echocardiography remains essential for comprehensive assessment and should not be replaced by ECG findings alone.
Abstract

Keywords:
12-lead electrocardiogramatrial septal defectright ventricular dilatationterminal D1S + D3R

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