Murni et al reported an electrocardiographic score for predicting pulmonary hypertension in a pediatric patient with atrial septal defect. The authors are from Universitas Gadjah Mada (Indonesia), Nagoya University, Kobe University and Kobe Pharmaceutical University.
Patient selection: pediatric patient with atrial septal defect, age < 18 years
Parameters:
(1) QRS axis in degrees
(2) P wave in lead II in mm
(3) R without S in V1
(4) Q wave in V1
(5) right bundle branch block (RBBB)
(6) R wave at V1, V2 or aVR
(7) S wave in V6 or lead I
Parameter
Finding
Points
QRS axis
< 120 degrees
0
>= 120 degrees
2
P wave in lead II
< 3 mm
0
>= 3 mm
5
R without S in V1
no
-2
yes
4
Q wave in V1
no
0
yes
5
right bundle branch block
no
-2
yes
3
R wave in V1, V2 or aVR
all normal
-2
one or more high
2
S wave in V6 or lead I
both normal
-1
one or both abnormal
1
Interpretation:
• minimum score: -7
• maximum score: 22
• A score > 3 has a sensitivity of 0.76 and specificity of 0.97 for pulmonary hypertension (the paper says a cutoff of 3.5 but there are no decimal fractions).
Performance:
• The area under the ROC curve is 0.91.
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