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.