title: The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum-type atrial septal defect in adults.
abstract: BACKGROUND
  This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).
  
  
  METHODS
  Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.
  
  
  RESULTS
  The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = 0.11 and P = .004). A BL criterion value greater than 0 mV predicted a significant shunt ratio (Qp/Qs > or = 1.5) (odds ratio, 4.8; 95% confidence interval, 1.3, 18.1; P = or <.0001) with a sensitivity of 0.68 and specificity of 0.65.
  
  
  CONCLUSIONS
  Our results indicate that there is limited utility of the BL criterion at detecting right ventricular volume overload, although a BL criterion value greater than 0 mV being used to identify patients with significant intracardiac shunts yielded a sensitivity of 0.68 and specificity of 0.65.
authors: The Aga Khan University Hospital, Karachi, Pakistan. adeelmsiddiqui@gmail.com
authors: Adeel M
authors: AM
authors: Siddiqui
authors: Zainab
authors: Z
authors: Samad
authors: Nina
authors: N
authors: Hakacova
authors: James
authors: J
authors: Kinsella
authors: Cary
authors: C
authors: Ward
authors: Michael
authors: M
authors: White
authors: Anna Lisa C
authors: AL
authors: Crowley
authors: Galen S
authors: GS
authors: Wagner
authors: J Kevin
authors: JK
authors: Harrison
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult