ArticleCirculation reports2025
Echocardiographic Z-Score to Predict Pulmonary-Systemic Flow Ratio in Children With Atrial Septal Defect.
Article in Circulation reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The correlation between pulmonary-to-systemic flow ratio (Qp/Qs) and right heart enlargement in children with atrial septal defect (ASD) remains unclear. This study aimed to (1) assess echocardiographic Z-scores of the right heart, and (2) determine whether they predict Qp/Qs. Methods and Results: This retrospective study included 175 children (median age 6.8 years; 68 males) with isolated ASD who underwent cardiac catheterization between 2013 and 2020 at 2 centers in Japan. Patients with genetic anomalies or other conditions affecting right heart size were excluded. Echocardiographic parameters were measured, converted to a Z-score, and compared with the catheterization data. In all patients, the Qp/Qs on cardiac catheterization (cQp/Qs) significantly correlated with the Z-scores of the right ventricular end-diastolic diameter of the basal (RVB), mid-cavity (RVM), and longitudinal length (RVL; r=0.54, 0.57, and 0.52, respectively). The average of these 3 parameters (ARV) showed the strongest correlation (r=0.63). Z-scores of the right atrium, tricuspid valve, and pulmonary artery showed weaker correlations. An ARV cut-off of +2.0 best predicted cQp/Qs ≥1.5 (area under the curve 0.85; 95% confidence interval 0.79-0.92; sensitivity 76.8%; specificity 82.4%). Regression-predicted cQp/Qs also significantly correlated with measured cQp/Qs (r=0.63). Conclusions: ARV may be a useful, non-invasive marker for assessing cQp/Qs and determining the indication for closure in children with ASD.
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