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. 2019 Aug 13:13:1179546819869948.
doi: 10.1177/1179546819869948. eCollection 2019.

The Accuracy of Combined Electrocardiogram Criteria to Diagnose Right Atrial Enlargement in Adults With Uncorrected Secundum Atrial Septal Defect

Purwati Pole Rio  1 , Hariadi Hariawan  1 , Dyah Wulan Anggrahini  1 , Anggoro Budi Hartopo  1 , Lucia Kris Dinarti  1
Affiliations

The Accuracy of Combined Electrocardiogram Criteria to Diagnose Right Atrial Enlargement in Adults With Uncorrected Secundum Atrial Septal Defect

Purwati Pole Rio et al. Clin Med Insights Cardiol. .

Abstract

Background: Right atrium (RA) enlargement in uncorrected atrial septal defect (ASD) is due to chronic volume overload. Several electrocardiogram (ECG) criteria had been proposed for screening RA enlargement. This study aimed to compare the accuracy of ECG criteria in detecting RA enlargement in adults with uncorrected ASD.

Methods: This was a cross-sectional study involving 120 adults with uncorrected secundum ASD. The subjects underwent ECG examination, transthoracic echocardiography, and right heart catheterization. An RA enlargement was determined with RA volume index by transthoracic echocardiography. Various ECG and combined ECG criteria were evaluated. Statistical analysis was performed to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

Results: An RA enlargement was detected in 64.2% subjects. The P wave height > 2.5 mm in lead II criterion had the best specificity (100%) and PPV (100%), but low sensitivity (19%) and accuracy (48%). The combined 2 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1) had 82% sensitivity, 56% specificity, 73% accuracy, 77% PPV, and 63% NPV. The combined 3 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1, and P wave height > 1.5 mm in V2) had 35% sensitivity, 86% specificity, 53% accuracy, 82% PPV, and 43% NPV.

Conclusions: The combined 2 ECG criteria (QRS axis > 90° and R/S ratio > 1 in V1) had increased sensitivity, better accuracy, and more balance of PPV and NPV as compared with P wave > 2.5 mm in II criterion and combined 3 ECG criteria to diagnose RA enlargement in adults with uncorrected ASD.

Keywords: Secundum atrial septal defect; combined ECG criteria; electrocardiogram; right atrial enlargement; right atrial volume index.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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