Key result
Novel clinical and ECG score predicts significant RV dilation in rTOF with ~77% sensitivity.
Why the study?
CMR is the gold standard for assessing RV function in rTOF but is expensive and not always available, creating a need for accessible ECG parameters and scores to guide CMR timing.
Does an ECG-based clinical score predict right ventricular dilation in patients with repaired tetralogy of Fallot?
Observational (n=147)
Assessors blinded to CMR results
No
Does an ECG-based clinical score predict right ventricular dilation in patients with repaired tetralogy of Fallot?
Effect estimate: AUC 0.782 (95% CI 0.709-0.855)
A simple risk score incorporating age, QRS duration, QRS fragmentation, and transannular patch repair can predict right ventricular dilation in patients with repaired tetralogy of Fallot, helping guide the timing of CMR.
ECG parameters and risk score may help time CMR in rTOF; extends correlations but leaves open prospective validation before practice change.
Background Cardiac magnetic resonance (CMR) is the gold standard for assessing right ventricular (RV) function in repaired tetralogy of Fallot (rTOF), but it is expensive and not always available. ECG is a cost-effective, accessible alternative. This study evaluated ECG parameters, specifically QRS duration (QRSd) and QRS fragmentation (QRSf), to predict RV volumes and function, and developed a new score to guide CMR timing. Methods We retrospectively analysed 147 patients with rTOF with pulmonary regurgitation. ECG, echocardiographic and CMR data were collected. Receiver operating characteristic curves identified optimal cut-offs for predicting RV dysfunction and dilation. Logistic regression was used to determine predictors of RV dysfunction and dilation. Results QRSd showed moderate positive correlations with RV end-diastolic (EDVi) and end-systolic (ESVi) volume indices and negative correlations with RV ejection fraction (EF) and global radial strain. QRSf was associated with larger RVESVi and lower RVEF. We propose a simple risk score of age ≤20 years, QRSd≥160 ms, QRSf and transannular patch repair. A score >2.5 out of 5.5 predicted RVEDVi ≥150 mL/m2 with 76.5% sensitivity and 63.6% specificity. Conclusions This study highlights the value of ECG, particularly QRSd≥160 ms and QRSf, in predicting RV dilation in rTOF. The proposed score, based on clinical data and ECG parameters, offers a practical tool for guiding the timing of CMR.
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Satawichairut et al. (2025) conducted an observational in Repaired tetralogy of Fallot with pulmonary regurgitation (n=147). ECG-based risk score (age ≤20 years, QRSd ≥160 ms, QRS fragmentation, transannular patch) vs. Score ≤2.5 was evaluated on Prediction of significant right ventricular dilation (RVEDVi ≥150 mL/m2) using a risk score >2.5 (AUC 0.782, 95% CI 0.709-0.855). A novel clinical and ECG-based risk score >2.5 predicted significant right ventricular dilation (RVEDVi ≥150 mL/m2) with an AUC of 0.782, 76.5% sensitivity, and 63.6% specificity in patients with repaired tetralogy of Fallot.
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