12-lead electrocardiography-based scoringsystem for predicting the probability of atrial septal defect closure in adults with pulmonary hypertension.

Background

Assessing atrial septal defect (ASD) operability in patients with pulmonary hypertension (PH) is challenging in resource-limited settings due to restricted access to right heart catheterization (RHC). This study aims to develop and validate a 12‑lead electrocardiography (ECG)-based scoring system to predict ASD closure feasibility.

Methods

We conducted a cross-sectional study using ECG data from adult patients with isolated ASD in the COHARD-PH Registry. ASD was confirmed by echocardiography, and PH was diagnosed by RHC. Based on hemodynamic criteria, patients were classified as closure or non-closure. The Spiegelhalter Knill-Jones approach was used for model development, and the receiver operating characteristic (ROC) curve analysis assessed accuracy.

Results

Among 199 ASD patients, 58.7% had PH, and 76% had a pulmonary vascular resistance index (PVRI) >8 WU. Six ECG criteria were identified as predictors of ASD closure feasibility: (1) P amplitude in lead II ≥ 2.5 mm, (2) R in V1 > 6 mm, (3) ∑ (R in V1+ S in V5 or V6) > 10.5 mm, (4) QR pattern in V1, (5) negative T waves in V1-V3, and (6) S in V5 > 10 mm. Patients scoring -18 to -9 had a 98% probability of ASD closure, while those scoring 9 to 17 had only a 6% probability. The scoring system demonstrated an AUC of 0.911, with a sensitivity of 95.5% and specificity of 77.3%.

Conclusions

We developed a 12‑lead ECG-based scoring system that provides a practical and accessible method for identifying candidates for referral, particularly in resource-limited settings. Further validation in diverse populations is needed to enhance its clinical applicability.