{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:33:58Z","timestamp":1786365238511,"version":"build-2736575974"},"reference-count":31,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1047951126113602_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Left atrial enlargement is a surrogate marker for disease progression in congenital post-tricuspid left-to-right shunt lesions. Despite advanced imaging, a need persists for a more accessible modality like electrocardiography for early detection of left atrial enlargement. This study evaluates the diagnostic accuracy of established electrocardiography standards and a novel electrocardiography criterion (with altered position of chest leads) in identifying left atrial enlargement in children with post-tricuspid shunt lesions, enabling routine monitoring and timely referrals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951126113602_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This cross-sectional observational study enrolled 227 children (1 month\u201318 years) with post-tricuspid shunts (ventricular septal defect, patent ductus arteriosus, and aortopulmonary window). Left atrial volume determined by 2D echocardiography was used as the reference standard to compare the diagnostic accuracy of electrocardiography parameters (negative P-terminal force at V1, P\/PR segment, and bifid P wave) in detecting left atrial enlargement. The diagnostic accuracy of a novel method of measuring negative P-terminal force with lead V1 placed at the 2nd right intercostal space was compared with traditional electrocardiography parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951126113602_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Electrocardiography parameters showed diagnostic accuracy of 52.9\u201361.5%, sensitivity of 32.5\u201390.8%, and specificity of 17.8\u201389.7% for left atrial enlargement. Novel P-terminal force in V1 at the 2ndintercostal space (&gt;151.2 mm.ms) had 32.5% sensitivity, 89.7% specificity, and 59.5% accuracy. At the 4th Rt. Intercostal space (novel P-terminal force in V1 \u226540 mm.ms), it had 74.2% sensitivity, 42.1% specificity, and 59.0% accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951126113602_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Measurement of the terminal negative force of the P wave at 2nd intercostal space\u00a0has improved the specificity in the detection of left atrial enlargement. Future studies with higher sample sizes in a heterogeneous population might characterise this as a potential tool in detecting left atrial enlargement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1047951126113602","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T15:18:55Z","timestamp":1782227935000},"page":"1149-1156","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of electrocardiographic parameters to detect left atrial enlargement in children with post-tricuspid left-to-right shunt"],"prefix":"10.1017","volume":"36","author":[{"given":"Rohan Ambali","family":"Parambil","sequence":"first","affiliation":[{"name":"Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheeraj Deo","family":"Bhatt","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00qa63322","id-type":"ROR","asserted-by":"publisher"}],"name":"Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3331-7915","authenticated-orcid":false,"given":"Sakshi","family":"Sachdeva","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00qa63322","id-type":"ROR","asserted-by":"publisher"}],"name":"Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh Kumar","family":"Yadav","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00qa63322","id-type":"ROR","asserted-by":"publisher"}],"name":"Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia 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